后路交叉置钉技术在青少年脊柱侧凸治疗中的应用  

Application of bilateral interval pedicle screwing for adolescent scoliosis patients

作　　者：张彦[1] 陈博昌[1] 鲍琨[1] Zhang Yan;Chen Bochang;Bao Kun(Department of Orthopedics,Sixth People′s Hospital,Shanghai Jiaotong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院,上海市200433

出　　处：《临床小儿外科杂志》2017年第4期364-367,372,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨后路交叉置钉技术对于治疗青少年脊柱侧凸的临床疗效。方法 2010年1月至2014年1月,68例青少年脊柱侧凸病例,男10例,女58例,年龄11~16岁,平均13.5岁;其中4例为神经肌肉型脊柱侧凸,其余为特发性脊柱侧凸;术前冠状面主弯Cobb角平均56.2°,胸椎(T5~T12)后凸角度平均17.7°,手术方法为后路交叉置入椎弓根螺钉对脊柱侧凸进行矫正,对术后Cobb角、主弯Cobb角矫正率结果进行评价。结果术后随访12~40个月,平均22.5个月。术后主弯Cobb角矫正到18.5°,与术前比较有差异(t=3.705,P<0.01),末次随访时平均20.2°,与术后比无差异(t=1.053,P>0.05)。胸椎(T5~T12)后凸角术后平均22.8°,末次随访时平均23.2°,术前与术后、术后与末次随访相比较均无差异(P>0.05)。术后主弯Cobb角矫正率为70.5%,而末次随访时虽然主弯矫正率(69.4%)有一定丢失,但和术后比较无差异(t=0.126,P>0.05)。术后无患者出现脊髓或神经根损伤。末次随访时无内固定松动及断钉断棒,植骨融合牢固,均未出现明显的矫正丢失。结论对于青少年脊柱侧凸后路手术矫正,采用交叉置钉技术是一项值得推广的低费用、高安全的脊柱侧凸矫正技术。Objective To explore the clinical efficacy of bilateral interval pedicle screw placement for adolescent scoliosis MethodsA total of68patients(10boys and58girls)with adolescent scoliosis underwent posterior fusion using bilateral interval pedicle screw placement Their mean age was135years The preoperative angles of thoracic coronal and sagittal Cobb were56°and17°The variables of main sagittal and coronal Cobb angles at the immediate postoperative and the last follow-up,curve correction rate were measured and the clinical outcomes analyzed ResultsThe mean follow up period was225months And the mean immediate postoperative and last follow up main thoracic coronal Cobb angle were185°and202°No statistically significant differences existed between preoperative and immediate postoperative(P<001),but not between immediate postoperative and last follow-up(P>005)The mean thoracic sagittal Cobb angle improved from177°preoperatively to228°immediate postoperatively However,the change had no significant difference(P>005)The mean immediate curve correction rate of705%differed not from that of the last follow-up(P>005)At the last follow-up,bone fusion was achieved in all patients No instrumentation related complications were noted ConclusionBilateral interval pedicle screwing is safe and efficacious for adolescent scoliosis

关 键 词：青少年 脊柱侧凸 外科手术 随访研究 

分 类 号：R726.8[医药卫生—儿科]