特发性脊柱侧凸远端融合椎的选择  

Selection of the lowest instrumented vertebrae for adolescent idiopathic scoliosis

作　　者：仉建国[1] 张新华[2] 邱贵兴[1] 邢泽军[1] 王以朋[1] 沈建雄[1] 赵宇[1] 李书纲[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,北京100730 [2]山东省寿光市人民医院骨科

出　　处：《中华骨科杂志》2010年第4期321-324,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）远端融合椎（lowest instrumented vertebra，LIV）的选择标准。方法前瞻性分析按LIV标准进行融合的随访2年以上（24-36个月，平均29个月）的AIS患者共33例，男4例，女29例。按照北京协和医学院（Peking Union Medical College Hospital）分型Ⅰb2例，Ⅰc2例，Ⅱa3例，Ⅱb23例，Ⅱc13例，Ⅱd117例和Ⅲb3例。患者手术时年龄11～16岁，平均14．2岁。LIV的选择标准：术前站立前后位像上被骶正中线触及的最近端椎体，即触及椎体，其旋转范围在Ⅰ度以内，并在凹侧Bending像上2／3以上椎体落在Harrington稳定区内，不伴腰段或胸腰段后凸畸形。所有患者均采用椎弓根螺钉固定。观测指标包括躯干偏移、LIV倾斜度和LIV尾侧椎间盘开角，并分析LIV与稳定椎之间的关系。结果术前和末次随访时躯干偏移由（1．87±1．18）cm矫正至（0．97±0．69）cm（t=3．24，P=0．004）；术前和末次随访时LIV倾斜度由20．95°±7．51°矫正至4．57°±2．80°（矫正率为76．2％，t=10．10，P〈0．001）；术前和末次随访时的LIV尾侧椎间盘开角分别为4．90°±3．83°和5．43°±2．23°（t=0．14，P=0．626）。选择触及椎体作为LIV比选择稳定椎平均节省（1．14±0．73）个椎体。结论按此触及椎体标准选择LIV可获得良好的矫形效果并可保留更多的运动节段。Objective To establish the criteria of the lowest instrumented vertebrae（LIV） for adolescent idiopathic scoliosis （AIS）. Methods A consecutive of 33 cases with AIS receiving posterior correction and fusion following the LIV criteria with over 2 year follow-up （range, 24-36 months）were reviewed.There were 4 males and 29 females. The average age at surgery was 14.2 years. All cases were fused to the touched vertebra, which was defined as the most cephalad vertebrae touched by central sacrum vertical line with Grade Ⅰ or less rotation on the standing anterio-posterior radiograph, and two-thirds of its vertebral body can fall within the Harrington stable zone, and there was no kyphosis. The curve types included PUMC Ⅰ b in 2 cases, Ⅰ c in 2 cases, Ⅱa in 3 cases, Ⅱb2 in 3 cases, Ⅱcl in 3 cases, Ⅱdl in 17 cases and Ⅲb in 3 cases. All cases used pediele screw fixation. Radiographic measurements included trunk shift （TS）, lowest instrumented vertebrae tilting （LIVT）, LIV distal disc angulation （LIVA） on the standing anterio-posterior radiographs before and after surgery and at the final follow-up. The difference of fusion levels were also recorded. The data were checked for normality and equal variances, and the level of significance was set at P〈0.05. Results The TS was （1.87±1.18） cm before surgery and （0.97±0.69） cm at the final follow-up （t= 3.24, P=0.004）. The LIVT was corrected from 20.95°±7,51° before surgery to 4.570±2.80° at the final followup with a correction rate of 76.2%（t=10.10,P〈0.001）o The LIVA was 4.900±3.83° before surgery and 5.43°± 2.23° at the final follow-up （t=0.14, P=0.626）. Compared to fusion to the stable vertebrae, fusion to the touched vertebrae saved 1.14±0.73 mobile segments. Conclusion Fusion acording to this LIV criteria can achieve a good radiologic results and can save more mobile segments.

关 键 词：脊柱侧凸 青少年 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]