摘要
目的 探讨使用后路三维矫正技术治疗 90°以上脊柱侧凸的手术策略 ,并评价其疗效。 方法 自 1997年起治疗 90°以上脊柱侧凸 72例 ,其中特发性侧凸 48例 ,非特发性侧凸 2 4例。 6 2例先行一期前路脊柱松解或支撑性融合或骨骺阻滞 ,术后Halo牵引 14d ,行二期后路三维矫正术 (CD、CD Horizon和TSRH)。另 10例直接行一期后路矫正术。在后路手术中 ,对前突型胸椎侧凸 ,先从凹侧开始纠正 ;对腰椎侧凸、胸腰椎侧凸或后突型胸椎侧凸 ,则从凸侧开始纠正 ,按标准化去旋转原理或水平横向原理矫正 32例 ,采用多棒分段技术矫正 40例。 结果 72例患者无 1例死亡 ;1例出现暂时性神经功能障碍 ,9例术中横突或关节突骨折。随访 7～ 34个月 ,均未出现假关节或脱钩断棒 ,2例发生失偿。 72例冠状面平均矫正 5 8% ,40例有术前矢状面形态异常者有 32例完全达矢状面重建 ,余 8例有 5 6 %纠正 ,术后身高增加 4～ 15cm。随访时间在 1年以上的 47例平均冠状面纠正丢失 6° ,矢状面无纠正丢失。 结论 后路三维矫正技术对严重脊柱侧凸可达到满意的纠正 ,对躯干平衡的重建更优 ;
Objctive To establish the surgical strategy for scoliosis of more than 90° and evaluate the clinical results of posterior 3 dimensional correction techinque. [WT5”HZ]Methods[WT5”BZ] 72 patients have been operated on since 1997,including 48 with idiopathic scoliosis and 24 with non idiopathic scoliosis. 62 patients had two stage surgery, the first being anterior procedures including spinal release, strut grafting or epiphysiodesis. After a 14 day halo traction, they had a posterior correction with CD, CD Horizon and TSRH instrumentation. The other 10 patients had only one stage posterior CD or TSRH instrumentation. During the posterior procedure, correction was started on the concave side for thoracic lordoscoliosis.On the contrary, the initial correction was started on the convex side for the lumbar and thoracolumbar curves or thoracic kyphoscoliosis. Thirty two of the 72 patients were corrected with standard derotation technique or translation technique, the remaing 40 were corrected with segmental multi rod CD technique. [WT5”HZ]Results[WT5”BZ] No death was noted, and 1 patient had transient sphincter dysfunction. Nine patients had intraoperative transverse or articular fracture. Follow up for the 7 34 months′, showed no pseudarthrosis, and no mechanical complications. Two patients had a decompensation.The average frontal correction was 58%, 32 of the 40 patients with preoperatively sagittal deformity showed complete sagittal profile restoration, and 8 showed 56% sagittal correction. Postoperative tallness of 72 patients increased 4 15 cm. The average loss of frontal correction was 6° for 47 patients followed up for more than 1 year, but sagittal correction was maintained. [WT5”HZ]Conclusions[WT5”BZ] Posterior 3 dimensional technique shows satisfactory results for scoliosis correction, and is much better for spinal balance restoration. Adequate anterior release, application of segmental multi rod technique,and the mornitoring of SEP can minimize neurological complication.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2001年第2期102-105,T001,共5页
Chinese Journal of Surgery
