出 处:《中国矫形外科杂志》2015年第7期577-582,共6页Orthopedic Journal of China
摘 要:[目的]评估对具有良好柔韧性的特发性脊柱侧凸患者采用椎弓根螺钉间隔置钉三维矫形术后随访5年以上手术疗效。[方法]对51例侧凸角度<75°,柔韧度>40%的特发性脊柱侧凸患者,采用椎弓根螺钉间隔置钉三维矫形,分析术前、术后即刻及末次随访时主弯侧凸Cobb角、顶椎旋转、冠状面平衡、矢状面平衡及手术时间、术中失血量、并发症等。[结果]主胸弯侧凸Cobb角由术前(53.6±6.6)°矫正为(15.8±7.4)°,末次随访为(17.7±6.1)°;顶椎旋转由术前(21.4±7.1)°矫正为(9.6±3.0)°,末次随访时为(11.0±3.3)°;冠状面C7铅垂线与骶正中线距离术前、术后即刻及末次随访分别为(-6.3±11.2)mm、(-3.7±8.0)mm、(-3.9±5.5)mm;矢状面C7铅垂线与S1椎体后上缘距离术前、术后即刻及末次随访分别为(-13.3±10.7)mm、(-2.1±5.2)mm、(-2.9±5.0)mm。患者侧凸Cobb角、顶椎旋转、冠状面及矢状面平衡术前、术后比较差异均有统计学意义(P<0.05),末次随访与术后相比差异无统计学意义(P>0.05)。术后2例内固定失败,3例出现远端延长现象,1例发生伤口表浅感染。术中平均失血量为825 ml,手术时间为155 min。与常规手术方式相比,本组患者椎弓根螺钉置钉数量减少52%。[结论]对于良好柔韧性的特发性脊柱侧凸患者,采用椎弓根螺钉间隔置钉可获得良好的矫形效果,并具有缩短手术时间、减少术中失血、节省手术费用等优点。[Objective] This study aimed to evaluate the outcome of patients with flexible idiopathic scoliosis treated with interval pedicle screw fixation. All patients were followed up to with more than 5 years. [Methods] Fifty-one idiopathic scoliosis patients with spine curves 75° and flexibility 40% received correction surgery with interval pedicle screw fixation. The main curve Cobb angle,rotation of apical vertebra,coronal and sagittal balance before surgery,immediately after surgery and at final follow-up were analyzed. The operation time,blood loss and complications were also recorded. [Results] The main curve Cobb angle decreased significantly from( 53. 6 ± 6. 6) ° preoperatively to( 15. 8 ± 7. 4) ° immediately after surgery,and at the final follow-up,the mean Cobb angle was( 17. 7 ± 6. 1) °. Rotation of the apical vertebra was corrected from( 21. 4 ±7. 1) ° preoperatively to( 9. 6 ± 3. 0) ° postoperatively,and it was( 17. 7 ± 6. 1) ° at final follow-up. The coronal distance from C7 plumbline to CSVL were( 6. 3 ± 11. 2) mm,(-3. 7 ± 8. 0) mm and(-3. 9 ± 5. 5) mm preoperatively,postoperatively and at final follow-up,respectively,and the sagittal distance from C7 plumbline to SSVL were(-13. 3 ± 10. 7) mm,(-2. 1 ± 5. 2) mm and(-2. 9 ± 5. 0) mm,respectively. These radiological parameters were significant different between preoperatively and postoperatively immediately( P〈0. 05),and there were no difference between the values postoperatively immediately and those at final follow-up( P〉0. 05). Two patients were complicated with implant failures. An adding-on phenomenon was detected in 3 patients,and 1 patients had postoperative superficial wound infections. The mean blood loss during surgery was825 ml,and the mean operation time was 155 minutes. Compared with conventional methods,the interval pedicle screw fixation decreased up to 52% fewer screws. [Conclusion] Interval pedicle screw fixation showed satisfactory results for the treatment of fl
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