伴综合征脊柱侧凸患者手术治疗的风险评估及疗效分析  

Risks and outcomes of surgical treatment for severe syndromic and idiopathic scoliosis:a retrospective study

作　　者：吴健华[1] 王渭君[1,2] 付桂兵[3] 廖敬乐[1] 林子平[1] 冯贵游[1,4] 邱勇[2,5] 郑振耀[1,2] 

机构地区：[1]香港中文大学威尔斯亲王医院矫形外科及创伤学系 [2]香港中文大学-南京大学脊柱侧弯联合研究中心 [3]深圳市儿童医院小儿外科,518025 [4]香港大埔那打素医院骨科 [5]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中国脊柱脊髓杂志》2009年第6期437-441,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨伴综合征的脊柱侧凸患者手术治疗的风险及效果。方法:2000年8月至2006年4月共对15例伴有综合征的脊柱侧凸(SS)患者实行手术矫治,同期手术治疗侧凸严重程度匹配的特发性脊柱侧凸(IS)患者12例。回顾分析两组患者术前的侧凸情况、肺功能、骨密度,手术方法、时间、固定节段,侧凸矫正及随访时的矫正丢失等情况。结果:两组患者骨密度及胸主弯患者的肺功能均降低且组间无显著性差异。SS和IS分期手术者分别占40.0%和16.7%,前者高于后者但差异无统计学意义;平均手术时间分别为693min和508min(P<0.05),平均固定节段分别为12.9个和10.7个(P<0.05);胸主弯侧凸矫正率分别为49.4%和58.6%,两组无明显差异;腰主弯矫正率分别为48.8%和59.5%,后者高于前者(P<0.05);两组并发症及随访中的矫正丢失无明显差异。结论:SS患者和IS患者一样存在低骨密度,胸弯者也存在肺功能降低。SS患者的胸主弯矫正与IS患者无明显差异,但受到自身综合征的影响;腰主弯矫正较差,手术时间及融合节段均较IS患者明显增加。Objective：To study the risk and outcome of surgical treatment for syndromic scoliosis.Method：15 patients with syndromic scoliosis（SS） operated from Aug. 2000 to Apr. 2006 were reviewed,and 12 idiopathic scoliosis （IS） cases treated at the same period with similar curve severity were selected as control.The preoperative scoliosis,bone mineral density and pulmonary function,surgical strategy,operation time,fusion level,and serial data of curve correction at follow up were studied and compared between the two groups. Result：The mean preoperative Cobb＇s angles of the major thoracic curve were 92.1° and 74.1°,and the major lumbar curve were 77.8° and 82.3° in SS and IS group respectively.No difference was found in the Cobb＇s angle and curve flexibility between the two groups.Low bone mineral density and decreased pulmonary function were detected in both groups but there was not statistically significant difference between the two groups.40.0% and 16.7% of patients in the SS and IS group were treated with two-stage procedures respectively,but the difference was not significant. The mean operation time recorded in the SS and IS groups was 693min and 508min（P〈0.05）, fusion level was 12.9 and 10.7（P〈0.05）.Similar correction were obtained in the major thoracic curve（49.4% and 58.6%） in the SS and IS group,while lumbar curve correction（48.8% vs 59.5% ） were significant lower in the SS group （P〈0.05）.The complication rate and loss of curve correction during follow-up were similar in both groups.Conclusion：Similar low bone mineral density and impaired puhnonary function present in both SS and IS.The major thoracic curve correction is similar between two groups.However,poor lumbar curve correction,longer operation time and more fusion levels needed can be observed in SS patients which might be related to the syndrome itself.

关 键 词：脊柱侧凸 综合征 骨密度 肺功能 手术风险 

分 类 号：R682.3[医药卫生—骨科学]