潘廷明;徐皓;姚晓东;陈建梅;李金泉;

• 1:福建医科大学福总临床医学院骨科

摘要(Abstract)：

[目的]回顾分析三维矫形内固定手术治疗青少年特发性脊柱侧凸(AIS)的临床效果,探讨经后路椎弓根钉系统三维矫形的生物力学及避免脊柱失平衡的对策。[方法]2005年1月～2007年6月在本院行三维矫形内固定手术的AIS患者31例,男18例,女13例;年龄11～18岁,平均15.2岁。其中LenkeI型8例,LenkeⅡ型4例,Len-keⅢ型8例,LenkeⅣ型2例,LenkeV型5例,LenkeVI型4例。术前冠状面Cobb’s角平均54°,顶椎偏距平均5.8cm,躯干偏移距离平均2.6cm。根据患者畸形类型和柔韧性选择融合范围。术后及随访时在X线片上测量主弯冠状面的Cobb’s角、顶椎偏距、躯干偏移距离。[结果]术后随访1～3年,平均16个月,冠状面Cobb’s角平均残留24°,矫正率为61%;终末随访平均丢失4.0°,丢失率为8%;顶椎偏距平均残留2.5cm,矫正率为56%,终末随访时平均丢失0.5cm,丢失率为8.5%;终末随访时躯干偏移距离平均1.0cm。[结论]后路椎弓根钉系统矫治青少年特发性脊柱侧凸具有优越的力学基础,因此能有效改善AIS畸形,但术中需始终关注躯体和脊柱的力学平衡。

关键词(KeyWords)： 青少年特发性脊柱侧凸;三维矫形;生物力学

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 潘廷明;徐皓;姚晓东;陈建梅;李金泉;

Email:

DOI:

参考文献(References)：

• [1]Harrington PR.Surgical instrumentation for management of scoliosis[J].Bone Joint Surg Am,1960,42:1448.
• [2]Humke T,Grob D,Scheier H,et al.Cotrel-Dubousset and Harring-ton instrumentation in idiopathic scoliosis:a comparison of long-term results[J].Eur Spine,1995,4:280-283.
• [3]Potter BK,Lehman RA,Kuklo TR,et al.Anatomy and biomechanics of thoracic pedicle screw instrumentation[J].Curr Opin Orthop,2004,15:133-144.
• [4]王守丰,邱勇,王斌,等.青少年特发性脊柱侧凸患者凸凹侧椎体生长板组织形态学研究[J].中国矫形外科杂志,2008,19:1499-1502.
• [5]Suk SI,Lee CK,Min HJ,et al.Comparison of Cotrel-Dubousset ped-icle screws and hooks in the treatment of idiopathic scoliosis[J].Int Orthop,1994,18:341-346.
• [6]Potter BK,Kuklo TR,Lenke LG,et al.Radiographic outcomes of ante-rior spinal fusion versus posterior spinal fusion with thoracic pedicle screws for treatment of Lenke type I adolescent idiopathic scoliosis curves[J].Spine,2005,30:1859-1866.
• [7]Kim YJ,Lenke LG,Cho SK,et al.Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adoles-cent idiopathic scoliosis[J].Spine,2004,29:2040-2048.
• [8]Kuklo TR,Potter BK,Lenke LG,et al.Surgical revision rates of hooksversus hybrid versus screws versus combined anteroposterior spinal fu-sion for adolescent idiopathic scoliosis[J].Spine,2007,32:2258-2264.
• [9]Kuklo TR,Potter BK,Lenke LG,et al.Monaxial versus multiaxial tho-racic pedicle screws in the correction of sdolescent idiopathic scoliosis[J].Spine,2007,30:2113-2120.
• [10]张鹏,刘国辉,杨述华,等.骨移植在青少年特发性脊柱侧凸后路矫形术的应用研究[J].中国矫形外科杂志,2008,21:1609-1612.