摘要
[目的]探索能反映治疗生长中儿童侧弯生长捧调控作用的X线检查方法,并验证板-棍系统(plate-rod system for scoliosis,PRSS)的调控能力。[方法]对31例置入PRSS的早发型脊柱侧弯进行至少2年的随访,收集术前、术后即刻、术后每次随访的站立位全脊柱正侧位X线片,测量其Cobb角和能反映顶椎楔形变程度的顶椎楔变角(apical vertebral wedge angle,AVWA),分析不同侧弯类型和不同手术时年龄组术后生长发育期间的顶椎椎体两侧生长速度差异、变化趋势与调控作用的关系。[结果]术前Cobb角平均63.74°±20.99°,术后矫正为25.38°±14.76°,末次随访时为31.68°±19.53°,无明显矫正丢失(P>0.05)。术后即刻AVWA平均13.74±5.88°,末次随访时平均8.74°±5.08°,平均减小5.00°±4.46°,差异有统计学意义(P<0.05)。AVWA的度数在术后总体呈下降趋势,反映侧弯椎体凹侧的生长速度超过凸侧。先天性脊柱侧弯的AVWA虽然在术后的测量起始阶段大于特发性脊柱侧弯的AVWA,但两者角度在术后的生长期间,总体都呈减小趋势,只是前者波动较明显。5岁前接受PRSS治疗的脊柱侧弯,其初始AVWA较小,且术后AVWA减小过程更平稳。[结论]测量术后生长中儿童侧弯的顶椎楔变角(AVWA),发现楔形变程度变小,是由于PRSS放置后使顶椎体两侧不对称生长发生了逆转,使凹侧生长速度超过凸侧,椎体两侧高度差减小造成的,反映了PRSS对儿童脊柱侧弯椎体两侧生长速度的调控作用。测量比较AVWA的变化是评价生长棒调控效果的一种可靠的检查方法。
[Objective] Tc investigate the growth modulation effect of plate-rod system for scoliosis （PRSS） in the management of progressive scoliosis in children. [Methods] Thirty-one early-onset scoliosis （EOS） patients who had been treated by PRSS were followed up for more than 2 years. The anteroposterior and lateral standing spinal radiographs were taken in all patients pre-, post-operatively and at each time point of follow up. The Cobb angle and apical vertebral wedge angle （AVWA） were measured for assessment of the height difference between two sides of the vertebrae. Afterwards, the relationship between the change of AVWA and modulation in growth period after operation was analyzed. [Results] The mean Cobb angle was corrected firm （63.74±20.99）° preoperatively to （25.38±14.76）° after surgery, and （31.68±19.53） ° at the last follow-up, without obvious loss of correction （P〉0.05） . The average AVWA improved from （13.74±5.88） ° immediately after operation to （8.74±5.08）° at the last follow-up, with an average decline of （5.00±4.46）° showing a statistically sig- nificant difference （P〈0.05） . Additionally, the AVWAs in the congenital scoliosis group were larger than those in the idio- pathic scoliosis group immediately after surgery, however, gradually decreased in both 2 groups, which indicated that growth rate at the concavity side was superior to that at the convexity side. In the patients who underwent PRSS surgery at age less than 5 years, the apical vertebrae were less wedging, and the change of AVWA in later growth period after PRSS was more stable than those more than 5 years. [Conchtsion] Measurement of AVWA reveals that the growth rate at the concavity side exceedea side exceed the convexity side after PRSS instrumentation,which indicates that PRSS has an ability of reversing asymmetrical growth in the scoliotic spine.Therefore,this is a reliable method to evaluste the modulation of growing rod.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第15期1367-1371,共5页
Orthopedic Journal of China
