摘要
目的对脊柱侧凸矫治术中应用全椎弓根螺钉技术的疗效进行回顾性分析,并评价其安全性.方法自2002年7月～2004年12月对40例特发性脊柱侧凸患者应用全椎弓根螺钉技术进行矫治,其中男12例,女28例.根据Lenke分型,Ⅰ型16例,Ⅱ型2例,Ⅲ型5例,Ⅴ型7例,Ⅵ型10例.与同期54例应用胸椎弓根、椎板钩联合腰椎弓根螺钉的脊柱侧凸患者进行比较,通过比较2组主侧凸冠状面矫正率、代偿侧凸自动矫正率、躯干平衡指标及矫正度丢失来评价其疗效.并对其中侧凸类型、节段完全一致的10例LenkeⅠ型患者的远端融合节段进行比较.结果随访6～20个月,平均12个月.术前主侧凸冠状面平均Cobb角62.4°,代偿侧凸33.7°,术后矫正率与自发矫正率分别为71.2%与65.4%,优于对照组的59.6%与60.2%,术后矢状面矫正与对照组相比无明显差异;随访中矫正度丢失平均1.9°,亦优于对照组的3.3°.远端融合节段比对照组平均节约1.2个.未发生神经系统并发症.结论掌握脊柱侧凸椎弓根解剖变化(尤其在胸椎),辅助影像学检查及神经功能监测,应用全椎弓根螺钉技术能取得较好的矫形效果及较少的并发症,远期疗效有待进一步随访观察.
Objective To analyze the efficacy of all pedicle screws technique applied to the treatment of idiopathic scoliosis and evaluate its safety. Methods Forty cases of idiopathic scoliosis were treated by all pedicle screws technique from July 2002 to December 2004, including 12 males and 28 females. According to Lenke classification, 16 cases were type Ⅰ , 2 type Ⅱ, 5 type Ⅲ, 7 type Ⅴ and 10 type Ⅵ. Compared with 54 cases using thoracic hooks combined with lumbar pedicle screws, the efficacy of all pedicle screws technique was evaluated by correction rate of main curve in coronary plane, spontaneous correction rate of compensatory curve, trunk balance index and lost of correction. Ten cases of Lenke type I with the same curve type and segments were also taken to compare the distal fused segments. Results The follow-up period lasted 6-20 months with an average of 12 months. Preoperative mean Cobb angles of main curve and compensatory curve in coronary plane were respectively 62.4 degrees and 33.7 degrees, and postoperative correction rate and spontaneous correction rate were respectively 71.2% and 65.4% excelled to the control group of 59.6% and 60.2%. There was no significant difference of correction in sagittal plane between two groups. The mean lost of correction was 1.9 degrees also excelled to the control group of 3.3 degrees. The distal fused segments were averagely saved 1.2 segments to the control group. No neurological complication occurred. Conclusion Mastering the pedicular anatomy of scoliosis especially at thoracic by imaging examination and neurological monitoring with the application of all pedicle screws technique could gain a good effect of correction with less complications. Lone-term efficacy needs further observation.
出处
《脊柱外科杂志》
2005年第4期208-211,共4页
Journal of Spinal Surgery
基金
军队"十五"科研基金资助项目(01MA149)
国家自然科学基金资助项目(024119027)
关键词
胸椎
脊柱侧凸
内固定器
全椎弓根螺钉
thoracic vertebrae
scoliosis
internal fixators
all pedicle screws
