青少年Chiari畸形伴胸椎侧凸远端融合范围的选择及疗效比较  

Selection of the lower instrumented vertebra in adolescents with thoracic scoliosis secondary toChiari malformation

作　　者：朱泽章 江龙 邱勇 刘臻 钱邦平 吴涛 伍伟飞 闫煌 

机构地区：[1]大学医学院附属鼓楼医院脊柱外科,南京210008

出　　处：《中华骨科杂志》2013年第5期433-439,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金面上项目（81171672）;中困博士后基金特别资助项目（2012T50491）

摘　　要：目的探泔青少年Chiari畸形伴胸椎侧凸不同远端固定肖段的选择对手术疗效的影响。方法后路选抒性脚椎融合术且随访超过2年的青少年共27例，男11例，女16例；年龄为12-18岁，平均15．2岁，记录术前、术后以及末次随访时的临床资料及影像学指标：冠状丽侧凸Cobb角、侧凸柔韧性、顶椎偏移（apical vertebral translation，AVT）、顶椎旋转（apical vertebral rotation，AVR）及躯干偏移；矢状面胸椎后凸角（thoraric kyphosis，TK）、胸腰段Cobb角（thoracolumbar kyphosis，TLK）、腰椎丽凸角（1umbar lordosis，L：．）及躯干偏移（sagittal vertical axis，SVA），并进行统计学分析．．结果随访时间2-7年，平均3．4年。末次随访时的胸弯矫正率为55．9％，矫正丢火率2.3％，腰弯自发矫正率为59．2％．术前腰弯修正为A型与B型两组患者末次随访时各项影像。学指标的差异均无统计学意义。除腰弯修正为B型h远端固定椎为L1的病例末次随圻时的平均LL（59．8°）明显大于L2者（40.8°）外，A刑及B型病例中远端固定椎化于L1或L2行其他各项影像学指标的差异均无统计学意义。结论术前腰巧修正为A型及B型的青少年Chiari畸形伴胸椎侧凸患者采川后路选择性胸椎融合术治疗，可获得满意的胸弯矫正及腰弯的自发性矫正。Objective To investigate the effect of lowest instrumented vertebrae （LIV） sclection onclinical outcome of posterior thoracic fusion in adolescents with thoracic scoliosis secondary to Chiari malformation. Methods A total of 27 adolescents with Chiari malfiwmation-associated scoliosis, who had undergone posterior thoracic fi,sion and heen followed up for at least 2 years, were enrolled in this study. There were 11 males and 16 females, with an average age of 15.2 years （range, 12 to 18 years）. The following radiographic parameters： coronal Cobb angle, curve flexibility, apical vertebral translation （AVT）, apical vertebral rotation （AVR）, trunk shift （C7PL-CSVL distance）, thoracic kyphosis （TK）, lumbar lordosis （LL）, thoracolumbar kyphosis, and sagittal vertical axis （SVA） were recorded preoperatively, immediately after surgery and at the last folluw-up. Results All the patients received a followed-up from 2 to 7 years （average, 3.4 years）. At the last follow-up, the average correetion rate of thoracic curve was 55.9% with an average correction loss rate of 2.3%. The spontaneous correction rate of lumhar curve was 59.2% on average. At the last follow-up, no significant difference in terms of the radiographic parameters was found between patients with lumbar modifier ＂A＂ and ＂B＂. In patients having the lumbar modifier ＂A＂, the LIV was at L1 in 6 cases and at L2 in 7 eases. As for those with lumbar modifier ＂B＂, the LIV located at L1 in 6 eases,L2 in 4 cases, and L2 in 1 case. A,nong patients with lumbar modifier ＂B＂, the LL was significantly higher in cases with LIV at Lt when compared with those with LIV at L,. Conclusion Selective thoracic fusion can provide a satisfactory outcome in adolescents with Chiari malformation-associated scoliosis with lumbar modifier ＂A＂ and ＂B＂.

关 键 词：ARNOLD-CHIARI畸形 脊柱侧凸 胸椎 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]