黄紫房;杨军林;王其飞;李佛保;林翔;谢红波;谢超凡;王丽琴;

• 1:南方医科大学解剖教研室
• 2:中山大学附属第一医院脊柱外科
• 3:中山大学附属第一医院 影像科

摘要(Abstract)：

[目的]比较VCM去旋转技术(vertebral column manipulator,VCM)和旋棒技术(rod derotation,RD)治疗青少年特发性脊柱侧凸(AIS)的矫正效果。[方法]回顾性分析2008年9月～2011年7月本中心采用VCM去旋转技术矫正的AIS患者20例,其中男6例,女14例;平均年龄14.5岁(10～18岁);取同期采用旋棒技术矫正的AIS患者20例,其中男3例,女17例;平均年龄14.6岁(10～18岁)。两组病例均具有完整的临床资料和术前术后全脊柱X线片、CT平扫+三维重建资料。研究收集两组患者的7项影像数据,包括主弯顶椎旋转角及其矫正率,主弯Cobb角及其矫正率,T_(5～12)后凸角,主弯顶椎偏移(AVT),C_7铅垂线偏移骶骨中央垂线距离(C_7-CSVL),C_7铅垂线偏移骶骨后上角距离(C_7-SSVL),下融合椎倾斜角(LIV-tilt)及其矫正率,并利用统计学独立样本t检验对两组病例术前术后的影像参数进行比较。[结果]两组患者均获得良好的侧凸矫正及冠状面、矢状面平衡重建,术中术后无严重并发症发生。VCM组的主弯顶椎旋转矫正率明显优于RD组,其值分别为平均(62.3±19.5)%和(24.7±22.5)%(P<0.05)。冠状面上,VCM组和RD组的主弯矫正率无明显统计学差异(P>0.05),其均值分别为(79.6±10.4)%和(81.0±10.4)%;虽然两组的LIV-tilt角矫正率无明显统计学差异,但VCM组的矫正率明显高于RD组(VCM组:RD组=75.6%VS 61.6%)。矢状面上,两组患者的术后胸椎后凸和矢状面平衡皆得到良好维持。[结论]VCM去旋转技术矫正青少年特发性脊柱侧凸顶椎旋转的效果优于旋棒技术,并具有潜在矫正下融合椎倾斜角及维持良好胸椎后凸的作用。

关键词(KeyWords)： 脊柱侧凸;椎体操作;旋棒技术;顶椎

Abstract:

Keywords:

基金项目(Foundation): 中山大学5010基金资助项目(编号:2012003)

作者(Author): 黄紫房;杨军林;王其飞;李佛保;林翔;谢红波;谢超凡;王丽琴;

Email:

DOI:

参考文献(References)：

• [1]Clayton JA,Geoffrey NA,FRACS,et al.Gravity - induced torque and intravertebral rotation in idiopathic scoliosis[J].Spine,2008, 2:30-37.
• [2]Lee SM,Suk SI,Chung ER.Direct vertebral rotation:a new technique of three - dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis[J].Spine, 2004,29:343-349.
• [3]Michael SC,Lawrence GL.Vertebral derotation in adolescent idiopathic scoliosis[J].Oper Tech Orthop,2009,19:19 -23.
• [4]Lawrence GL,Randal RB.Jiirgen H,et al.Adolescent idiopathic scoliosis:a new classification to determine extent of spinal arthrodesis [J].J Bone Joint Surg Am,2001,83:1169 - 1181.
• [5]Kuklo TR,Potter BK,Lenke LG.Vertebral rotation and thoracic torsion in adolescent idiopathic scoliosis:what is the best radiographic correlate[J].J Spinal Disord Tech,2005,2:139 -147.
• [6]Gardner - Morse M,Stokes IA.Three - dimensional simulations of the scoliosis derotation maneuver with Cotrel - Dubousset instrumen- tation[J].J Biomech,1994,2:177-181.
• [7]Lenke LG,Bridwell KH,Blanke K,et al.Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis[J].Spine,1995,12:1343 -1350.
• [8]Suk SI,Lee CK,Kim WJ,et al.Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis[J].Spine,1995,12: 1399 -1405.
• [9]Gabriel PV,Jesu' s BF,Ignacio ST,et al.Vertebral coplanar alignment a standardized technique for three dimensional correction in scoliosis surgery:technical description and preliminary results in lenke type 1 curves[J].Spine,2008,14:1588 - 1597.
• [10]Parent A,Tim Odell BS,Richard Oka BA,et al.Does the direction of pedicle screw rotation affect the biomechanics of direct transverse plane vertebral derotation[J].Spine,2008,18:1966 - 1969.
• [11]Ivan C,David H,Alex I,et al.Biomechanical analysis of derotation of the thoracic spine using pedicle screws[J].Spine,2010,10:1039 -1043.
• [12]Ibrahim O,Nicolas A,Anouar B,et al.Correction of axial vertebral rotation in adolescent idiopathic scoliosis:comparison of two surgical techniques[J].J Bone Joint Surg Br,2011,93:501.
• [13]Mladenov KV,Vaeterlein C,Stuecker R.Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis:effects on the sagittal alignment[J].Eur Spine J,2011,7: 1114-1117.
• [14]Hwang SW,Samdani AF,Gressot LV,et al.Effect of direct vertebral body derotation on the sagittal profile in adolescent idiopathic scoliosis [J].Eur Spine J,2011,30.