后路分段小切口进路建立幼猪脊柱侧凸模型的实验研究  

Establishment of piglet model of scoliosis by posterior spinal tethering through separated incisions

作　　者：郑欣[1] 邱勇[1] 钱邦平[1] 孙旭[1] 王斌[1] 俞扬[1] 朱泽章[1] 吴涛[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华小儿外科杂志》2013年第9期690-694,共5页Chinese Journal of Pediatric Surgery

基　　金：江苏省“333工程”第三层次培养对象资助项目和南京市医学科技发展重点项目共同资助（201108016）

摘　　要：目的探讨后路单侧栓系建立幼猪的快速进展性脊柱侧凸模型的可行性。方法选择6只雌性约克夏幼猪（6周龄，6～8kg），采用分段小切口的方式，在T5、T6及L2、L3左侧植入椎弓根螺钉固定，同侧竖脊肌旁切口暴露并绑扎第10-13肋骨，适当加压行钢缆栓系，使脊柱凸向右侧，建立脊柱侧凸模型，建模时间8周。术后每4周摄脊柱X线片和CT影像学检查。建模8周后，将后路内固定取出，不做任何治疗，继续观察4周记录侧凸变化。结果5只幼猪成功建立了脊柱侧凸模型，表现为进展性结构性脊柱侧凸，1只因感染导致内固定松动，栓系失败。术后即刻Cobb角平均为19．6°（14°～27°），经过8周栓系，进展为55．2°（38°～76°）。栓系去除后4周，侧凸仍然稳定在51．2°。所有侧凸均表现出显著的顶椎偏移中线以及顶椎旋转等特征，CT三维重建显示主弯曲内脊柱前后结构完整，没有任何融合迹象。结论本研究在幼猪中通过后路单侧栓系成功建立了快速进展的结构性脊柱侧凸模型，由于避免了脊柱侧凸主弯结构的损伤，适用于矫形技术的研究。Objective To evaluate the feasibility of developing a rapidly progressive scoliosis model in piglets by posterior asymmetric tethering. Methods Six female piglets （age： 6 weeks old, weight： 6 - 8 kg） were instrumented and tethered using a three separate incisions fashion. Minimal dissection at the left T5-T6 and L2-L3 allowed for pedicle screw placement. Ipsitateral rib cage tethering of left T10-T13 ribs was then performed through a left-sided paramedian incision. Through mild intraoperative tensioning and repositioning of the animal with a right coronal curvature, a mild deformity was achieved. The tethering period of our scoliosis model was 8 weeks. Progressive spinal deformity was documented by serial X-ray and computed tomography （CT）. After 8 weeks, the posterior instrument was removed and the piglets were followed up over a 4-week period with serial radiographs to document changes of the deformity. Results One pig encountered substantial complications （infection and failure of the tether）. The rest 5 piglets developed progressive, structural scoliosis. The mean initial Cobb angle of the scoliosis after posterior asymmetric tethering was 19. 6° （range 14°-27°） and it progressed to 55. 2° （range 38°-76°） after the 8 week tethering period. The curvature remained stable （51.2°） during the 4 weeks after removal of the tethering. All curves demonstrated characteristic radiographic features including significant translation of the apical vertebrae from the midline, apical vertebrae rotation. CT three-dimensional reconstruction showed that the anterior and posterior elements of the curvature were intact and no signs of fusion were detected. Conclusions Posterior asymmetric tethering is an effective way of establishing piglet model of rapidly progressive structural scoliosis, It avoids the damage to the spinal elements throughout the maximal portion of the curve and could be an ideal model for further study on corrective techniques.

关 键 词：脊柱侧凸 猪 模型 动物 

分 类 号：R687.3[医药卫生—骨科学]