前路松解术在重度青少年特发性脊柱侧凸治疗中的价值  

The effect of anterior spinal release on severe adolescent idiopathic scoliosis

作　　者：王以朋[1] 徐宏光[1] 邱贵兴[1] 仉建国[1] 于斌[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院骨科,100730

出　　处：《中华外科杂志》2004年第2期77-80,共4页Chinese Journal of Surgery

摘　　要：目的　探讨前路松解在重度青少年特发性脊柱侧凸治疗中的作用。　方法　回顾性分析 1998年 1月至 2 0 0 1年 12月间 2 6例重度脊柱侧凸的手术治疗结果 ,其中男 7例 ,女 19例 ;年龄平均 15岁 (10～ 2 1岁 )。 2 4例可根据King对特发性脊柱侧凸的分型 ,其中KingⅠ 4例 ,KingⅡ 9例 ,KingⅢ 5例 ,KingⅣ 4例 ,KingⅤ 2例 ;另 2例为胸腰段侧凸。术前站立位主侧凸平均 89 8° ,重力悬吊牵引位平均 6 6 5°,反向弯曲位平均 6 7 7°,支点反向弯曲平均为 6 1 2° ,胸椎后凸平均 4 3 5°。术前顶椎偏离骶正中线的距离为 39 7mm。前路松解后一期行后路手术 6例 ,2周后二期行后路手术治疗 2 0例。　结果　 2 0例二期后路手术者 ,前路松解术后脊柱活动度与术前悬吊位X线片比较 ,平均增加了 17 8°。术后主侧凸冠状面Cobb角平均 5 2 6° ,胸椎后凸 2 8 4°。冠状面平均矫正 38 2° ,矫正率平均 4 3 1% ,术后顶椎偏离骶正中线的距离为 9 9mm。随访时间平均 2 3年 (6个月～ 4年 ) ,随访时主侧凸平均Cobb角 5 4 9° ,矫正丢失 6 4 % ,无断棍、植骨不融合及假关节的病例。　结论　重度侧凸术前侧凸的柔韧性 <2 0 %的患者 ,单纯前路松解对增加脊柱的活动度意义不大 ,术后畸形的矫正效果不佳 ,应考虑前路的截骨来增加?Objective To explore the effect of anterior spinal release on severe scoliosis. Methods Twenty-six cases of severe scoliosis were retrospectively reviewed from January 1998 to December 2001. There were 7 males and 19 females with an average age of 15 years (ranging from 10 to 21 years). Twenty-four cases were classified according to King classification for adolescent idiopathic scoliosis,including King type Ⅰ 4 cases,type Ⅱ 9 cases,type Ⅲ 5 cases,King Ⅳ 4 cases,KingⅤ 2 cases;another two cases were thoracolumbar curve. The major curves were averaged respectively 89.8°,66.5°,67.7°,61.2°on standing,traction,bending and fulcrum film before operation. The distance of apex vertebrae deviated from sacral midline was 39.7 mm before operation. Results Six cases received anterior spinal release with posterior correction by one stage,20 cases by two stages. The cases with two stage operation increased the spinal flexibility about 17.8° after anterior release. The major curve was 52.6° on average,and the distance of apex vertebrae deviated from sacral midline was 9.9 mm after operation. The major curve was 54.9° on average,loss the correction 6.4% during follow-up. There was no complication related to the operation in this group. Conclusions The anterior spinal release alone has little effect on severe scoliosis with flexibility less than 20% preoperation. The curve can be corrected to a great degree by anterior osteotomy for spine.

关 键 词：前路松解术 青少年 特发性脊柱侧凸 治疗 

分 类 号：R687[医药卫生—骨科学]