短钉多点锚定与钉钩混合系统矫治神经纤维瘤病脊柱侧凸的比较  

Multiple-point anchoring with short screw versus hybrid instrumentation for dystrophic scoliosis secondary to neurofibromatosis type-1

作　　者：张宏其[1] 邓盎[1] 郭超峰[1] 唐明星[1] 刘少华[1] 王昱翔[1] 高琪乐[1] 刘金洋[1] ZHANG Hong-qi;DENG Ang;GUO Chao-feng;TANG Ming-xing;LIU Shao-Hua;WANG Yuxiang;GAO Qi- le;LIU Jin- yang(Xiangya Spinal Surgery Center,Department of Spinal Surgery,Xiangya Hospital,CentralSouth University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院脊柱外科湘雅脊柱外科中心

出　　处：《中国矫形外科杂志》2019年第17期1537-1542,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目（编号：81772298）;湖南省重点研发计划项目（编号：2017SK2062）;湖南省自然科学青年基金项目（编号：2016JJ3160）

摘　　要：[目的]比较后路短钉多点锚定与钉钩混合系统矫治Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的疗效。[方法]回顾性分析2005年~2017年手术治疗的Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸患者42例,其中,21例采用后路短钉多点锚定钉棒系统矫治,21例采用钉钩混合系统矫治。比较两组手术时间、出血量、融合节段数;影像测量冠状面Cobb角、顶椎偏距、顶椎旋转度、矢状面后凸。[结果]两组患者均顺利手术,均未出现神经、血管损伤等严重并发症。多点锚定组手术时间稍长、术中出血量稍多于混合系统组,但差异无统计学意义(P>005)。平均随访时间多点锚定组(39.75±20.06)个月,混合系统组(34.50±13.77)个月,两组患者一般情况好,患者外形、躯干平衡较术前明显改善。影像学评估方面,两组患者术后和末次随访时主弯冠状面侧凸Cobb角、顶椎偏距、顶椎旋转度、矢状面后凸Cobb角均较术前显著减少,差异有统计学意义(P<0.05)。多点锚定组在术后即刻和末次随访时的主弯冠状面Cobb角、顶椎偏距、顶椎旋转度均小于混合系统组,差异有统计学意义(P<0.05)。多点锚定组矫正丢失率为(2.20±2.21)%,而混合系统组为(3.57±1.40)%。[结论]对Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的矫治,短钉多点锚定与钉钩混合系统均可获得较满意的矫形融合效果,而短钉多点锚定的畸形矫正率更高,矫正丢失率更低。[Objective]To compare the clinical and radiographic outcomes between multiple-point anchoring with short screw in pedicle screw-rod system and hybrid instrumentation for treatment of dystrophic scoliosis secondary to neurofibromatosis type-1.[Methods]From 2005 to 2017,a total of 42 patients with dystrophic scoliosis secondary to neurofibromatosis type-1 underwent surgical treatment in our department.Based on instrumentation used,21 patients had spinal deformity corrected with multiple-point anchoring by short screw in pedicle screw-rod system,while the remaining 21 patients received internal fixation with a hybrid instrumentation combined screw with hook.The operation time,intraoperative blood loss,segments fused and parameters radiographically measured,such as coronal Cobb angle of main curve,apical vertebral translation(AVT),apical vertebral rotation(AVR),sagittal kyphosis(SK)were compared between the two groups.[Results]All the patients had surgical procedures performed smoothly without serious complication,such as neurovascular injuries.The multiple-point anchoring groups consumed longer operation time,associated with more intraoperative blood loss than the hybrid instrumentation group,although the differences were not statistically significant(P>0.05).During the follow-up period,all the patients in both groups were in a good general condition,and achieved remarkable improvement in body configuration,with a proper trunk balance compared with those before operation.In term of radiographic assessment,the coronal Cobb angle,AVT,AVR,and SK immediately after operation and at the latest follow up significantly decreased in both groups compared with those preoperatively(P<0.05).The multiple-point anchoring groups proved significantly less coronal Cobb angle,AVT,AVR immediately after operation and at the latest follow up than the hybrid instrumentation group(P<0.05).The correction loss rate in the coronal Cobb angle between the time points immediately after operation and the latest follow up proved of(2.20±2.21)%in

关 键 词：神经纤维瘤病 营养不良性脊柱侧凸 多点锚定 钉钩混合系统 

分 类 号：R682.3[医药卫生—骨科学]