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背景:主弯Cobb角大于65°、柔韧性小于34.5%的重度僵硬性青少年特发性脊柱侧凸多以传统的前后联合入路手术矫正,但并发症较多。应用使单纯后路手术对矫正置入椎弓根螺钉固定材料植入并植骨融合是否会有更好的效果?目的:评价单纯后路矫正椎弓根螺钉固定材料并植骨融合术矫正治疗重度僵硬性青少年特发性脊柱侧凸的效果。设计:病例分析。单位:上海交通大学医学院附属仁济医院骨科。对象:选择1999-06/2005-08在上海交通大学医学院附属仁济医院骨科收治的20例重度僵硬性青少年特发性脊柱侧凸患者,男8例,女12例,年龄12～18岁,平均15岁。均经全脊柱X片确诊。King-Moe分型Ⅰ型4例,Ⅱ型6例,Ⅲ型5例,Ⅳ型3例,Ⅴ型2例。术前侧凸主弯平均Cobb角82°(75o～92o),平均柔韧性为30%(20%～40%),术前平均双肩高度差为15mm(5～35mm)。患者中Risser征1度3例,2度5例,3度6例,4度5例,5度1例。患者及家属均对治疗知情同意,实验经过医院伦理委员会批准许可。本组患者所用的人工骨为美国Wright公司的产品Osteoset。方法:患者均行单纯后路矫正椎弓根螺钉固定植骨融合手术,暴露预定融合范围内椎体的棘突、椎板、关节突关节及横突。暴露完成后先根据进钉点的解剖标志以徒手技术在术前确定的“关键性椎体”上置入椎弓根螺钉。其中6例手术以TSRH系统进行固定,其余手术均以CDHM8系统固定。术后评估手术时间及失血量。术后7d采用X线测量患者Cobb角,计算主弯矫正率,同时评估双肩高度差及住院时间。术后4年随访患者并发症及恢复情况。主要观察指标:①手术时间及失血量。②Cobb角及主弯矫正率。③双肩高度差及住院时间。④随访结果。结果:患者20例均进入结果分析。①手术时间及失血量:手术时间为3.2～4.3h,平均3.5h;失血量为660～1070mL,平均865mL。②Cobb角及主弯矫正率:术后主弯平均Cobb角从术前的82°(75o～92o)矫正到31°(22°～37°),平均矫正率为62%。③双肩高度差及住院时间:术后脊柱侧位片均显示患者胸腰椎基本恢复正常后凸及前凸,平均双肩高度差为7.5mm(0～11mm),患者住院日为8～11d,平均9d。④随访结果:所有患者均获术后4年随访,所有侧凸主弯矫正角度未发生丢失,固定节段全部融合,无断钉、断棒发生。结论:单纯后路椎弓根螺钉内固定材料置入并植骨融合术能有效治疗主弯在75o～92o,柔韧性≥20%的重度僵硬性青少年特发性脊柱侧凸。
Background: Severe and rigid adolescent idiopathic scoliosis with Cobb angle greater than 65 ° and less than 34.5% flexion is more often treated by traditional anterolateral posterior approach, but with more complications. Application of simple posterior surgery for correction of pedicle screw fixation and bone graft fusion will have a better effect? Objective: To evaluate the simple posterior correction of pedicle screw fixation and bone graft fusion surgery Effect of severe idiopathic adolescent idiopathic scoliosis. Design: Case Analysis. SETTING: Department of Orthopedics, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. PARTICIPANTS: Totally 20 adult patients with severe idiopathic adolescent idiopathic scoliosis were enrolled in Department of Orthopedics, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 1999 to August 2005. There were 8 males and 12 females aged 12-18 years , Average 15 years old. All spine X-ray confirmed. There were 4 cases of type Ⅰ, 6 cases of type Ⅱ, 5 cases of type Ⅲ, 3 cases of type Ⅳ and 2 cases of type Ⅴ. The average Cobb angle of the main curve before operation was 82 ° (75o ~ 92o) with mean flexibility of 30% (20% ~ 40%). The average preoperative shoulder height difference was 15mm (5 ~ 35mm). Risser sign in patients with 1 degree in 3 cases, 2 degrees in 5 cases, 3 degrees in 6 cases, 4 degrees in 5 cases, 5 degrees in 1 case. Informed consent was obtained from both patients and their relatives. The experiment was approved by the Hospital Ethics Committee. The artificial bone used in this group of patients is Osteoset, a product of Wright Company. Methods: All patients underwent posterior simple pedicle screw fixation and fusion surgery to expose the spinous process, vertebral lamina, facet joint and transverse process of the vertebral body within a predetermined fusion range. After the exposure is completed, the pedicle screw is placed on the “critical vertebral body” preoperatively determined according to the anatomical landmarks of the nailing point using the bare hands technique. Among them, 6 cases were fixed by TSRH system and the rest were fixed by CDHM8 system. Postoperative assessment of operation time and blood loss. The Cobb angle was measured by X-ray on the 7th day after surgery. The correction rate of the main curve was calculated. The shoulder height difference and hospital stay were also evaluated. Four-year follow-up of patients with complications and recovery. MAIN OUTCOME MEASURES: ① operation time and blood loss. ② Cobb angle and the main bend correction rate. ③ shoulder height difference and hospitalization time. ④ follow-up results. Results: Twenty patients were involved in the result analysis. ① operation time and blood loss: operation time was 3.2 ~ 4.3h, an average of 3.5h; blood loss of 660 ~ 1070mL, an average of 865mL. Cobb angle and main curve correction rate: The average Cobb angle of the main curve was corrected from 82 ° (75 ° ~92 °) before surgery to 31 ° (22 ° ~ 37 °) with an average correction rate of 62%. ③ shoulder height difference and length of stay: The posterior column radiographs showed that the thoracolumbar vertebrae returned to normal with normal kyphosis and anterior convexity, the average shoulder height difference was 7.5mm (0 ~ 11mm), and the hospitalization days were 8 ~ 11d. The mean 9d. ④ Follow-up results: All patients were followed up for 4 years after operation. All the corrections of the main curve were not lost, all the fixed segments were fused, no broken screws and broken rods occurred. Conclusions: Posterior simple pedicle screw fixation and bone graft fusion can effectively treat severe and rigid idiopathic scoliosis with 75o ~ 92o flexion and 20% flexibility.