青少年特发性脊柱侧凸前路矫形策略回顾分析Surgical strategy of lowest instrumented vertebrae selection of anterior correction for adolescent idiopathic scoliosis
刘洋;李明;朱晓东;施鹏;陈华江;王新伟;袁文;
摘要(Abstract)：
[目的]分析青少年特发性脊柱侧凸前路矫形中末端融合椎(LIV)的选择策略,并探讨末端融合椎与躯干平衡的关系。[方法]对获得完整随访资料的28例青少年特发性胸腰椎/腰椎侧凸患者(Lenke 5型)进行回顾性研究,这些患者均接受前路硬棒系统矫形手术,平均随访1.5年(1~3年),统计分析LIV与融合椎体节段数、椎间盘楔形变、LIV倾斜度、躯干平衡指标等影像学资料之间的关系,分析椎间盘楔形变与躯干平衡之间的关系。[结果]术前末端椎椎间盘角度(2.96°±1.43°),术后(-3.60°±1.75°),术后椎间盘楔形变程度与LIV倾斜度关系最为密切(P<0.01),躯干总体平衡与LIV-CSVL(骶中线)、融合节段数及LIV倾斜显著相关。[结论]LIV的选择与多个影像学指标相关,对于下端椎与上一椎体椎间盘角度较大,该椎体与顶椎之间椎体少,距离CSVL较远,倾斜角度较大的患者,不适于选择短节段融合。若手术未融合平行的椎间盘,则术后椎间盘楔形变发生的几率较高。
关键词(KeyWords)： 青少年特发性脊柱侧凸;前路脊柱融合;椎间盘楔形变;末端融合椎
基金项目(Foundation): 国家自然科学基金(NO30571888)
作者(Author): 刘洋;李明;朱晓东;施鹏;陈华江;王新伟;袁文;
Email:
DOI:
参考文献(References)：
- 〔1〕Majd ME,Castro FP,Holt RT.Anterior fusion for idiopathic scoliosis[J].Spine,2000,25:696-702.
- 〔2〕Sweet FA,Lenke LG,Bridwell KH,et al.Prospective radiographic and clinical outcomes and complications of single solid rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis[J].Spine,2001,26:1956-1965.
- 〔3〕Turi M,Johnston II CE,Richards BS.Anterior correction of idiopathic scoliosis using TSRHinstrumentation[J].Spine,1993,18:417-422.
- 〔4〕Ouellet JA,Johnston II CE.Effect of grafting technique on the mainte-nance of coronal and sagittal correction in anterior treatment of scolio-sis[J].Spine,2002,27:2129-2136.
- 〔5〕Bitan FD,Neuwirth MG,Kuflik PL,et al.The use of short and rigid anterior instrumentation in the treatment of idiopathic thoracolumbar scoliosis[J].Spine,2002,27:1553-1557.
- 〔6〕Hall JE,Millis MB,Snyder BD.Short segment anterior instrumentation for thoracolumbar scoliosis.In:Bridwell KH,DeWald RL,eds.The Textbook of Spinal Surgery,2nd ed[M].Philadelphia,PA:Lippincott-Raven,1997,665-674.
- 〔7〕Kaneda K,Shono Y,Satoh S,et al.Newanterior instrumentation for the management of thoracolumbar and lumbar scoliosis[J].Spine,1996,21:1250-1262.
- 〔8〕Potter BK,Kuklo TR,Lenke LG.Radiographic outcomes of anterior spinal fusion versus posterior spinal fusion with thoracic pedicle screws for treatment of Lenke TypeⅠadolescent idiopathic scoliosis curves[J].Spine,2005,30(16):1859-1866.
- 〔9〕Spiegel DA,Cunningham BW,Oda I,et al.Anterior vertebral screw strain with and without solid interspace support[J].Spine,2000,25:2755-2761.