青少年特发性脊柱侧弯凸侧旋棒矫形与凹侧旋棒矫形的手术效果评估  

Evaluation of corrective effect of adolescent idiopathic scoliosis patients treated by convex and concave rod derotation

作　　者：黄紫房[1] 杨军林[2] 林翔[2] 李佛保[2] 谢超凡[2] 王其飞[2] 

机构地区：[1]南方医科大学解剖教研室,广州510515 [2]中山大学附属第一医院脊柱侧弯中心,广州510080

出　　处：《中国矫形外科杂志》2012年第24期2246-2249,共4页Orthopedic Journal of China

摘　　要：[目的]比较青少年特发性脊柱侧凸(AIS)采用后路凸侧旋棒矫形与凹侧旋棒矫形的手术效果。[方法]收集本中心2008年7月～2011年7月收治的AIS患者61例,年龄10～18岁,术前主弯均<70°。按术中矫形技术分为凸侧旋棒矫形组(n=34)和凹侧旋棒矫形组(n=27),所有患者均具有完整的术前、术后全脊柱X线片。研究收集两组患者的术前、术后主弯Cobb角及其矫正率、T5～12后凸角、顶椎偏移距离(AVT)、C7偏离骶骨中央垂线距离(C7-CSVL)和C7偏离骶骨后上角距离(C7-SSVL),置钉密度,并进行统计学比较。[结果]两组患者皆成功获得手术矫正,术中、术后无严重并发症发生;术前主弯Cobb角分别从平均47.9°±9.9°和51.4°±8.8°(P=0.148),矫正至术后平均8.2°±5.2°和14.0°±8.5°(P=0.002),平均矫正率为(82.5±10.5)%和(73.4±13.9)%(P=0.005);T5～12后凸分别从术前平均17.7°±12.2°和20.6°±13.7°(P=0.377),矫正至术后平均19.7°±9.8°和18.3°±8.7°(P=0.558);术后冠状面和矢状面皆获得良好平衡。[结论]AIS后路凸侧旋棒矫形较凹侧旋棒矫形具有更好的主弯矫正率,并可潜在增加脊髓神经安全性;两组患者术后皆能维持良好的胸椎后凸。[ Objective ] To evaluate the radiographic outcomes of AIS patients treated by convex rod derotation and concave rod derotation maneuver. [ Method] A retrospective study was designed to compare 2 cohorts including 61 AIS patients （ Cobb angle 〈 70°） treated by convex rod derotation（ n = 34） and concave rod derotation technique （ n = 27 ） from July 2008 to July 2011. All patients had complete record and whole spine PA and lateral X-ray film before and after operation, six radiographic variables of pre-operation and post-operation were collected andcompared between both groups, including Cobb angle and correc- tive rate of main curve,kyphosis of Ts 5-12 ,apical vertebral transition （AVT） ,the coronal C7 to center sacral vertical line （ C7 - CSVL） ,the sagittal C7 to center sacral vertical line （C7 -SSVL）, screw density. A statistical t-test of these six variables was taken between both groups. [ Result] Scoliosis was successfully corrected in both groups without severe complications during or after operation. There were no significant differences of six radiographic parameters between two groups, except the postoperative Cobb angle of main curve and its corrective rate. The Cobb angles of main curve in convex rod derotation group and concave rod derotation group were corrected from 47.9° ＋ 9.9° and 51.4° ± 8.8 °（ P = 0. 148）preoperatively to 8.2° ± 5.2° and 14.0° ± 8. 5 °（ P = 0. 002 ） postoperatively , corrective rates were 82.5 % ± 10.5 % and 73.4% ± 13.9% （P = 0. 005 ）, kyphosis of T5 -12 were corrected from 17.7° ± 12.2°and 20.6° ±13.7° （ P = 0. 377 ） preoperatively to 19.7° ± 9.8° and 18.3° ± 8.7° （ P = 0. 558） postoperatively. Both groups got good coronal and saggital balance. [ Conclusion] Convex rod derotation technique can im- prove corrective rate of main curve than concave rod rerotation technique in AIS patients, and potentially improves the safety of spine cord and nerve. The T5-12 kyphosis was maintained in both groups.

关 键 词：脊柱侧凸 矫形 凸侧 凹侧 旋棒技术 

分 类 号：R687.3[医药卫生—骨科学]