胸腔镜下前路松解后路混合钉钩内固定治疗严重特发性胸椎侧凸  

Anterior endoscopic release/posterior spinal instrumentation for severe and rigid thoracic adolescent idiopathic scoliosis

作　　者：邱勇[1] 王渭君[1] 朱锋[1] 朱泽章[1] 王斌[1] 俞杨[1] 

机构地区：[1]南京大学医学院附属鼓楼医院骨科,210008

出　　处：《中华外科杂志》2011年第12期1071-1075,共5页Chinese Journal of Surgery

基　　金：卫生部公益性行业专项资助项目（201002018）

摘　　要：目的比较胸腔镜下前路松解后路混合钉钩内固定融合术（APSF）与单一后路全椎弓根螺钉内固定（PSSF）治疗严重特发性胸椎侧凸的疗效。方法回顾性分析2001年11月至2008年12月采用APSF治疗的特发性胸椎侧凸患者资料，选择其中胸椎Cobb角≥70°、柔韧性≤50％的患者作为研究对象（APSF组），并选择同期胸椎侧凸严重程度和柔韧性匹配的行PSSF治疗的患者作为对照（PSSF组）。全部患者术后均随访I〉24个月。APSF组有患者18例，PSSF组27例，两组患者平均年龄分别为（15．9±2．1）岁和（15．8±2．9）岁。在两组患者术前、术后及末次随访时检查的站立位全脊柱正侧位X线片上测量胸主弯侧凸Cobb角、胸椎后凸（T5～T12）Cobb角，对两组的影像学参数、固定节段、植入物密度及并发症情况进行比较。结果APSF组和PSSF组术前胸主弯侧凸Cobb角平均分别为87°±12°和79°±8°，平均固定节段（12．7±1．2）个和（12．8±1．4）个，植入物密度分别为48％±5％和61％±6％，术后平均矫正率为58％±13％和59％±8％；两组患者平均随访（4．5±0．6）年和（2．8±0．7）年，末次随访时矫正丢失分别为4．4°和1．9°。APSF组植入物密度较PSSF组低（t=6．123，P〈0．001），两组患者术前、术后和末次随访时胸椎侧凸及后凸差异均无统计学意义（P〉0．05）。结论对于严重僵硬型特发性胸椎侧凸，通过增加植入物密度，PSSF可获得与APSF一样的疗效。但对于有高度发生矫正丢失、内固定并发症或假关节风险的患者，仍然建议采用APSF方案。Objectives To compare the results of spinal correction for severe and rigid thoracic adolescent idiopathic seoliosis （T-AIS） by combined anterior endoscopic release / posterior hybrid constructs of proximal hooks and distal pediele screws spinal fusion （APSF） and an all-pedicle screw construct posterior-only spinal fusion （PSSF）. Methods T-AIS patients with curves ≥ 70° and flexibility ≤50% who underwent APSF from November 2001 to December 2008 were retrospectively reviewed （ APSF group）. In addition, the patients treated by PSSF with comparable curve severity and flexibility were selected as control （PSSF group）. All patients had a minimum 2-year follow-up. The thoracic curve and kyphosis were measured on standing long-cassette posteroanterior and lateral radiographs of entire spine taken at pre- operation, post-operation and last follow-up. The radiographic parameters, fusion levels, implant density and complications were compared between two groups. Results There were 18 patients treated with APSF and 27 with PSSF, with mean age of （ 15.9 ± 2. 1 ） years and （ 15.8 ± 2. 9） years, respectively. In patients treated with APSF, the mean thoracic curve was 87° ± 12° with 58% ± 13% correction after operation; while in those treated with PSSF, the mean thoracic curve was 79°± 8°with 59% ± 8% correction after operation. The number of levels fused was 12. 7 ± 1.2 and 12. 8 ± 1.4, while the implant density was 48% ± 5% and 61% ± 6% in APSF group and PSSF group, respectively. Patients treated with APSF and PSSF were followed by （4. 5 ±0. 6） years and （2. 8 ±0. 7） years, with a mean loss of correction of 4. 4° and 1.9°at final follow-up. Despite the significant higher implant density found in PSSF（ t = 6. 123, P 〈 0. 001 ）, there were no statistically significant differences between the groups for gender, age, number of levels fused, preoperative coronal/sagittal Cobb measurements, coronal curve flexibility, or amount of postoperative coronal Cobb correction.

关 键 词：脊柱侧凸 胸椎 胸腔镜检查 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]