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目的探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)矫形手术中使用不同内固定棒的效果。方法收集2011年1月~2013年8月本院收治的AIS患者临床资料(n=134)。根据手术中使用的内固定棒类型将患者分为钴铬棒(cobalt chromium,Co Cr)组(n=33)和同直径的钛棒(titanium,Ti)组(n=101)。术前、术后及末次随访时拍摄脊柱X线片并测量冠状面主弯Cobb角、胸椎后凸角、胸腰段前凸角、腰椎前凸角,进行对比研究。结果 Co Cr组患者主弯角度术后为14.72°±5.01°,末次随访为16.12°±5.48°,末次随访主弯角度丢失1.40°±3.07°;胸椎后凸角术后为22.19°±5.44°,末次随访为21.27°±5.34°。Ti组患者主弯角度术后为17.37°±12.10°,末次随访为20.25°±9.56°,末次随访主弯角度丢失2.89°±4.27°;胸椎后凸角术后为18.02°±7.98°,末次随访为16.53°±6.93°。2组术后主弯角度、末次随访主弯角度、末次随访主弯角度丢失、术后胸椎后凸角、末次随访胸椎后凸角,差异均有统计学意义(P<0.05)。结论在AIS矫形中,与钛棒相比,钴铬棒可在冠状面上提供更大的矫形力,更重要的是可以防止由于矫形引起的矢状面胸椎后凸角减少,维持较好的矢状面生理曲度。
Objective To investigate the effect of using different internal fixation rods in adolescent idiopathic scoliosis (AIS) orthopedic surgery. Methods The clinical data of AIS patients admitted from January 2011 to August 2013 in our hospital (n = 134) were collected. Patients were divided into cobalt chromium (Co Cr) group (n = 33) and titanium (Ti) group (n = 101) according to the type of internal fixation rod used in the operation. The preoperative, postoperative and final follow-up photographs of the spine X-ray and measurement of the coronal primary curve Cobb angle, thoracic kyphotic angle, thoracolumbar lordosis angle, lumbar lordosis angle for comparative study. Results In the group of patients with Co Cr, the angle of the main bend was 14.72 ° ± 5.01 ° and the final follow-up was 16.12 ° ± 5.48 °. The angle of the main curve at the final follow-up was 1.40 ° ± 3.07 °. The angle of the thoracic kyphosis was 22.19 ° ± 5.44 ° , The last follow-up was 21.27 ° ± 5.34 °. The main bending angle of patients in Ti group was 17.37 ° ± 12.10 ° postoperatively and the final follow-up was 20.25 ° ± 9.56 °. The final bending angle of the final follow-up was 2.89 ° ± 4.27 °, and the post-thoracic kyphotic angle was 18.02 ° ± 7.98 ° Follow-up was 16.53 ° ± 6.93 °. There were significant differences between the two groups in postoperative main bending angle, the final follow-up of the main bending angle, the loss of the main bending angle in the last follow-up, the posterior thoracic kyphotic angle, and the last follow-up of the thoracic kyphotic angle (P <0.05). Conclusions In AIS orthopedics, cobalt-chromium rods provide greater orthopedic force on the coronal plane than titanium rods and, more importantly, prevent sagittal thoracic kyphotic kyphosis reduction due to orthosis, and maintain a good Sagittal physiology.