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目的:评价后路选择性胸腰弯或腰弯融合治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的临床效果。方法:回顾性分析45例行后路选择性胸腰弯(20例)或腰弯(25例)融合的Lenke 5C型AIS病例,男4例,女41例,平均年龄14.9±2.1岁(12~20岁)。所有病例均行后路椎弓根螺钉内固定矫形融合,平均随访36±20个月(24~105个月)。术前、术后及末次随访时均摄站立位全脊柱正侧位X线片,对躯干偏移、融合节段邻近椎间盘开角、远端融合椎的倾斜、冠状面和矢状面Cobb角进行测量分析。测量数据使用SPSS 17.0统计学软件进行分析。结果:术前胸腰弯或腰弯Cobb角平均47.3°±7.2°,术后矫正至6.4°±4.6°,矫正率(84.8±11.6)%,末次随访时为9.1°±5.4°,矫形丢失2.7°±4.6°。胸弯术前25.7°±7.4°,凸侧Bending像Cobb角7.6°±5.8°,柔韧性(72.7±23.0)%,术后矫正至13.2°±6.7°,自动矫正率(48.5±29.4)%,末次随访14.2°±7.6°,矫形丢失1°±6°。躯干偏移:术前21.3±11.5mm,术后19.5±13.3mm,末次随访10.9±8.9mm。术后近端与远端融合椎邻近椎间盘开角较术后明显减小,且在随访过程中无明显加重。远端融合椎倾斜术后及末次随访时均显著改善。末次随访时,交界性后凸1例,躯干失衡3例,胸弯失代偿并行融合延长手术1例。所有病例末次随访时均未见假关节形成。结论:后路选择性胸腰弯或腰弯融合对Lenke 5C型特发性脊柱侧凸可获得满意矫形效果,胸弯可获得良好的自动矫正,有效缩短了融合节段。
Objective: To evaluate the clinical effect of posterior selective thoracolumbar or lumbar fusion in the treatment of adolescent idiopathic scoliosis (AIS). Methods: 45 cases of Lenke type 5C with fusion of posterior thoracolumbar flexion (20 cases) or lumbar flexion (25 cases) were retrospectively analyzed. There were 4 males and 41 females with a mean age of 14.9 ± 2.1 years (12 ~ 20 years old). All patients underwent posterior pedicle screw fixation and orthopedic fusion. The patients were followed up for an average of 36 ± 20 months (24-105 months). At the time of preoperative, postoperative and last follow-up, all posterior lateral radiographs of the spine were taken, and the images of torso deviation, open angle of the intervertebral disc near the fusion segment, inclination of the distal fusion vertebra, coronal and sagittal Cobb angle Perform measurement and analysis. Measurement data were analyzed using SPSS 17.0 statistical software. Results: Preoperative thoracolumbar curve or lumbar Cobb angle average 47.3 ° ± 7.2 °, postoperative correction to 6.4 ° ± 4.6 °, the correction rate (84.8 ± 11.6)%, the last follow-up was 9.1 ° ± 5.4 °, the loss of orthopedic 2.7 ° ± 4.6 °. Flexion (72.7 ± 23.0)%, postoperative correction to 13.2 ° ± 6.7 °, automatic correction rate (48.5 ± 29.4)% , The last follow-up 14.2 ° ± 7.6 °, orthopedic loss 1 ° ± 6 °. Torso offset: preoperative 21.3 ± 11.5mm, postoperative 19.5 ± 13.3mm, the last follow-up 10.9 ± 8.9mm. Postoperatively, the open angle of proximal intervertebral disc between the proximal and distal fusion vertebrae was significantly reduced compared with that after operation, and no significant increase was observed during follow-up. Distal fusion vertebral incision and the last follow-up were significantly improved. At the last follow-up, there were 1 case of junctional kyphosis, 3 cases of trunk unbalance, and 1 case of concurrent thoracic extension and fusion surgery. No cases of pseudarthrosis were seen at the last follow-up of all cases. Conclusion: Posterior selective thoracolumbar fusion or lumbar fusion can achieve satisfactory orthopedic effect on Lenke type 5C idiopathic scoliosis. The thoracic curve can be corrected automatically and the fusion segment can be effectively shortened.