凸侧旋棒与凹侧旋棒矫正Lenke I型AIS至少2年随访效果评估  

Convex versus concave rod derotation maneuver for Lenke type I adolescent idiopathic scoliosis: a minimal 2-year follow-up study

作　　者：黄紫房[1] 杨靖凡[1] 杨军林[1] 王其飞[1] 范恒伟[1] 李佛保[1] 

机构地区：[1]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》2016年第13期1153-1157,共5页Orthopedic Journal of China

基　　金：中山大学临床医学研究5010计划项目(编号:2012003)

摘　　要：[目的]评估Lenke I型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）采用后路凸侧旋棒矫形与凹侧旋棒矫形至少2年的随访效果。[方法]收集本中心2008年7月～2011年7月间收治的Lenke I型AIS患者66例,平均年龄14.9岁,术前主弯均〈70°。按术中矫形技术分为凸侧旋棒组（32例）和凹侧旋棒组（34例）,所有患者均具有完整术前、术后及术后2年的全脊柱正侧位X线片以及术前、术后CT平扫。研究分析两组病例的主弯Cobb角及其矫正率、T_（5～12）后凸角、顶椎偏移距离（apical vertebral translation,AVT）、C_7偏离骶骨中央垂线距离（coronal C_7 to centre sacral vertical line,C_7-CSVL）和C_7偏离骶骨后上角距离（the sagital C_7 to centre sacral vertical line,C_7-SSVL）,置钉密度及置钉破壁率,并进行统计学比较。[结果]两组患者皆成功获得手术矫正,术中及术后2年随访无严重并发症发生;凸侧旋棒组和凹侧旋棒组的术前主弯Cobb角分别从平均（53.2±10.7）°和（51.2±10.8）°（P=0.455）矫正至术后平均（8.0±7.3）°和（12.9±7.0）°（P=0.008）,平均矫正率为（86.2±12.7）%和（75.3±13.0）%（P=0.001）;T_（5～12）后凸分别从术前平均（18.4±12.6）°和（23.2±19.3）°（P=0.248）,矫正至术后平均（20.2±10.9）°和（21.8±8.9）°（P=0.533）;术后冠状面和矢状面皆获得良好平衡。所有病例的凸侧和凹侧总椎弓根螺钉破壁率分别为1.2%和3.9%（P=0.162）;凸侧旋棒组和凹侧旋棒组的总椎弓根钉破壁率分别为1.3%和3.2%（P=0.01）。[结论]青少年脊柱侧凸采用凸侧旋棒技术矫正是一种安全有效的方法,较凹侧旋棒矫形具有更好的侧凸矫形效果和置钉安全性;结合胸椎小关节松解、体内折弯和增加凹侧预弯棒角度有助于矢状面后凸的维持或矫正,且至少2年随访的矫形效果维持良好。[Objective] To evaluate the radiographic outcomes of convex rod derotation versus concave rod derotation maneuver in the treatment of Lenke type I adolescent idiopathic scoliosis（ AIS）. [Methods] A retrospective study was designed to compare two cohorts including 66 Lenke type I AIS patients（ Cobb angle 〈70°） treated with convex rod derotation（ n = 32）and concave rod derotation technique（ n = 34） from July 2008 to July 2011. All patients had complete medical record and pre-and post- operative full- spine PA and lateral X- ray films. Seven variables included Cobb angle,T_（5 ~ 12） kyphosis,apical vertebral translation（ AVT）,C_7- CSVL,C_7- SSVL,nail density and the incidence of screw misplacement in the pre- and post- operative radiographs. A statistical t- test of these seven variables was taken in both groups. [Results] Scoliosis in both groups was successfully corrected without intra- and post- operative severe complications. There were no significant differences on the seven radiographic parameters between two groups,except the incidence of screw misplacement,the postoperative Cobb angle of main curve and its corrective rate. The Cobb angles of major curve in both the convex rod derotation group and the concave rod derotation group were corrected from（ 53. 2 ± 10. 7）° and（ 51. 2 ± 10. 8）° preoperatively（ P = 0. 455） to（ 8. 0 ± 7. 3）° and（ 12. 9 ± 7. 0） °（ P = 0. 008） postoperatively,with corrective rates of（ 86. 2 ± 12. 7） % and（ 75. 3 ± 13. 0） %（ P =0. 001）, respectively. The lost corrective rate were 2. 1% and 5. 1% at the last follow- up,respectively. T_（5 ~ 12） kyphosis were corrected from（ 18. 4 ± 12. 6）° and（ 23. 2 ± 19. 3） °（ P = 0. 248）preoperatively to（ 20. 2 ± 10. 9） ° and（ 21. 8 ± 8. 9） ° at last follow-up（ P = 0. 533）. Final coronal and sagittal balance was well achieved. The incidences rate of screw misplacement in the convex and concave side of all patients were 1. 2% and 3. 9% respectively,

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]