后路椎弓根钉系统三维矫形治疗青少年特发性脊柱侧凸  

Posterior three-dimensional correction surgery with pedicle screws for the treatment of adolescent idiopathic scoliosis

作　　者：潘廷明[1] 徐皓[1] 姚晓东[1] 陈建梅[1] 李金泉[1] 

机构地区：[1]福建医科大学福总临床医学院骨科,福州350025

出　　处：《中国矫形外科杂志》2009年第17期1293-1296,共4页Orthopedic Journal of China

摘　　要：[目的]回顾分析三维矫形内固定手术治疗青少年特发性脊柱侧凸(AIS)的临床效果,探讨经后路椎弓根钉系统三维矫形的生物力学及避免脊柱失平衡的对策。[方法]2005年1月～2007年6月在本院行三维矫形内固定手术的AIS患者31例,男18例,女13例;年龄11～18岁,平均15.2岁。其中LenkeI型8例,LenkeⅡ型4例,Len-keⅢ型8例,LenkeⅣ型2例,LenkeV型5例,LenkeVI型4例。术前冠状面Cobb’s角平均54°,顶椎偏距平均5.8cm,躯干偏移距离平均2.6cm。根据患者畸形类型和柔韧性选择融合范围。术后及随访时在X线片上测量主弯冠状面的Cobb’s角、顶椎偏距、躯干偏移距离。[结果]术后随访1～3年,平均16个月,冠状面Cobb’s角平均残留24°,矫正率为61%;终末随访平均丢失4.0°,丢失率为8%;顶椎偏距平均残留2.5cm,矫正率为56%,终末随访时平均丢失0.5cm,丢失率为8.5%;终末随访时躯干偏移距离平均1.0cm。[结论]后路椎弓根钉系统矫治青少年特发性脊柱侧凸具有优越的力学基础,因此能有效改善AIS畸形,但术中需始终关注躯体和脊柱的力学平衡。[ Objective] A retrospective study was performed to evaluate the outcome of three - dimensional correction for adolescent idiopathic scoliosis （AIS） and discuss biomechanics of posterior three - dimensional correction surgery and measures for the prevention of spinal imbalance. [ Methods ] Thirty - one patients with AIS were classified and treated with three - dimensional correction surgery from 2005 to 2007. There were 18 male and 13 female with the average age of 15.2 years （ range, 11 to 18 years） . The cases were classified according to the Lenke surgical classification, including type Ⅰ 8 cases, type Ⅱ 4 cases, type Ⅲ 8 cases, type Ⅳ 2 case, type Ⅴ 5 cases, type Ⅵ 4 cases. The major curve Cobb＇ s angles, the distance of apical vertebra shift and trunk shift, were measured and analyzed in the reoperative, postoperative and final follow - up radiographies. The average preoperative coronal Cobb＇ s angle was 54°, the distance of beth apical vertebra shift and trunk shift was 5. 8 cm and 2. 6 cm respectively. [ Results] The mean time of follow - up was 16 months （ range 1 to 3 years） . The average postoperative coronal Cobb＇ s angle was 21°, as the correction was 61%, the lost angle at the last follow - up was 4. 0°. The postoperative distance of apical vertebra shift was 2. 5cm, as the correction was 56%, the lost distance at the last follow -up was 0. 5 cm. The distance of trunk shift at the last follow - up was 1.0 cm. [ Conclusion ] Posterior three - dimensional correction surgery is a good corrective method in the treatment of AIS. The spinal mechanical balance should be noticed during the operalon.

关 键 词：青少年特发性脊柱侧凸 三维矫形 生物力学 

分 类 号：R687.3[医药卫生—骨科学]