肋骨结构性支撑植骨在脊柱侧凸前路矫形手术中应用的长期随访  

Application of rib strut grafting in anterior correction for adolescent idiopathic scoliosis:long-term follow-up

作　　者：卢文灿[1] 仉建国[2] 邱贵兴[2] 林佳俊[1] 刘文革[1] 王以朋[2] 任玉珠[2] 翁习生[2] 

机构地区：[1]福建医科大学附属协和医院骨科,福州350001 [2]中国医学科学院北京协和医院骨科,北京100730

出　　处：《中国矫形外科杂志》2013年第1期29-33,共5页Orthopedic Journal of China

摘　　要：[目的]评价肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合手术中应用的长期随访结果。[方法]回顾性分析术后随访时间超过4年的青少年特发性脊柱侧凸前路矫形手术病例30例,男3例,女27例;年龄12～17.5岁,平均14.3岁。侧凸类型包括PUMCⅠb型5例、Ⅰc型5例、Ⅱd1型20例。全部病例均行前路矫形融合手术,植骨方式采用自体肋骨结构性支撑植骨。术前、术后及随访时摄脊柱站立位X线片,测量冠状面及矢状面Cobb角,并观察植骨融合情况,有无假关节形成及内置物并发症。[结果]随访4～10.2年,平均6.3年。融合弯冠状面矫形率术后平均为75.1%,末次随访时矫形丢失平均4.6°;固定融合节段冠状面矫形率术后平均为93.2%,末次随访时丢失平均2.1°;固定融合节段矢状面Cobb角术前与术后比较无显著性差异,末次随访时矫形丢失平均3.1°。13例胸腰段后凸患者术前后凸平均8.3°,术后矫正为前凸平均5.6°,末次随访时保持前凸平均3.7°。全部病例末次随访时均未见假关节形成或内置物并发症。[结论]肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合手术中能获得并维持良好的冠状面及矢状面矫形,且融合率高、远期矫形丢失少,是一种可靠、有效的植骨方法。[ Objective] To evaluate the long-term results of anterior spinal fusion （ASF） for adolescent idiopathic scoliosis （AIS） using rib strut grafting technique. [ Method] Thirty AIS cases receiving ASF with single solid rod instrumentations and receiving over 4 years follow-up were reviewed. There were 3 males and 27 females with an average age of 14.3 years,the aver- age follow-up was 6.3 years （ range,4 - 10.2 years）. The types of curve included PUMC I b in 5, I c in 5, I] dl in 20 cases. All of them underwent anterior thoracolumbar or lumbar fusion using rib strut grafting. The coronal and sagittal Cobb＇s angles were measured on the standing anterioposterior and lateral radiographs before surgery, after surgery and at the follow-up. [ Resuit] The coronal correction rate of the fused curve was 75.1% after surgery with an average 4.6° loss of correction at the final follow-up. For the instrumented segments,the coronal correction rate was 93.2% after surgery with an average 2.1 ° loss at the final follow-up, while no significant change was noted at the sagittal plane before and after surgery and the correction loss was 3. 1 o at the final follow-up. In 13 cases with thoracolumbar kyphosis before surgery, the Cobb angle was corrected from 8.3 ° kyphosis to 5.6° lordosis after surgery, and 3.7° lordosis at the final follow-up. No pseudarthroses or implant failures were observed at the final follow-up. [ Conclusion] The appropriate rib strut grafting showed excellent results in achieving and maintaining the correction of the coronal and sagittal curvature with no pseudarthrosis and implant failure in the anterior correction of AIS.

关 键 词：青少年特发性脊柱侧凸 前路脊柱融合 结构性支撑植骨 肋骨 

分 类 号：R687.3[医药卫生—骨科学]