CHEN Ting,FAN Qing,SHEN Pin,et al.Evaluation of pelvic fixation in neuromuscular scoliosis.[J].Journal of Clinical Pediatric Surgery,2010,9(04):0.
骨盆固定术在神经肌肉性脊柱侧凸中的应用
- Title:
- Evaluation of pelvic fixation in neuromuscular scoliosis.
- Keywords:
- Pelvis; Neuromuscular Manipestations; Scoliosis/CN
- 摘要:
- 目的 评价骨盆固定术在神经肌肉性脊柱侧凸患儿手术中的应用价值。 方法 回顾性分析55例神经性脊柱侧凸患儿临床资料。将患儿分为3组，第1组：骨盆倾斜度 > 15°，行骨盆固定术；第2组：骨盆倾斜度 > 15°，未行骨盆固定术；第3组：骨盆倾斜度 < 15 °、未行骨盆固定术。采用脊柱后路松解加骨盆固定手术，骨盆固定术采用髂骨钉固定。 结果 3组患儿术后Cobb’s角及末次随访较术前均有明显改善，Cobb’s角的矫正丢失度没有明显差异。3组术后骨盆倾斜度相比无明显差异，但在末次随访时比较，第2组与其他两组存在显著差异。 结论 骨盆倾斜度 < 15 °的患儿不需加行骨盆固定术也能保持良好的脊柱矫形与骨盆平衡，骨盆倾斜度 > 15 °的患儿需加行骨盆固定术才能获得良好的脊柱矫形与骨盆平衡。
- Abstract:
- Objectives To evaluate the indications of pelvic fixation in neuromuscular scoliosis patients. Methods We have measured the change in pelvic obliquity over a period of 25 months among three groups; group I with initial pelvic obliquity > 15° and pelvic fixation, group Ⅱwith initial pelvic obliquity > 15° and without pelvic fixation and group III with initial pelvic obliquity < 15° and without pelvic fixation. All patients underwent for correction and fusion for neuromuscular scoliosis using posterior-only pedicle screw instrumentations. We have used iliac screws for pelvic fixation in selected patient group. Results Comparing the Cobb's angle correction among all three groups there is significant correction post operatively and at final follow-up. There is no significant loss of correction among all three groups. However, when pelvic obliquity was compared in all three groups displayed significant correction post operatively,but group II exhibited significant loss of correction at final follow-up when compared with group I and group III. Conclusions Patients who have pelvic obliquity less than 15° do not need pelvic fixation and they can maintain the correction during a long period; while patients who have pelvic obliquity more than 15° require pelvic fixation to maintain the correction and balance over a long time.
参考文献/References:
1 King AG,Thomas KA.Analysis of the STIF Technique for Spino-Pelvic Fixation: Clinical Results in 19 Patients with Neuromuscular Scoliosis[J].Journal of Pediatric Orthopedics, 2000,20:667-676.
2 Hahn F,Hauser D.Scoliosis correction with pedicle screws in Duchenne muscular dystrophy[J].Eur Spine J,2008,17(2):255-261.
3 Sengupta DK,Mehdian SH.Pelvic or Lumbar Fixation for the Surgical Management of Scoliosis in Duchenne Muscular Dystrophy[J].Spine,2002, 27(18):2072-2079.
4 Allen B,Ferguson R.The Galveston technique of pelvic fixation with Luque rod instrumentation of the spine[J].Spine,1984,9:388-394.
5 Wild A,Haak H.Is Sacral Instrumentation Mandatory to Address Pelvic Obliquity in Neuromuscular Thoracolumbar Scoliosis Due to Myelomeningocele? [J].Spine,2001,26(14):325-329.
6 Whitaker C,Burton DC.Treatment of Selected Neuromuscular Patients With Posterior Instrumentation and Arthrodesis Ending With Lumbar Pedicle Screw Anchorage[J].Spine, 2000,25(18):2312-2318.
7 Peelle MW,Lenke LG.Comparison of Pelvic Fixation Techniques in Neuromuscular Spinal Deformity Correction: Galveston Rod Versus Iliac and Lumbosacral Screws[J].Spine, 2006,31(20):2392-2398.
8 Miladi LT,Ghanem IB.Iliosacral Screw Fixation for Pelvic Obliquity in Neuromuscular Scoliosis: A Long-Term Follow-Up Study[J].Spine,1997,22(15):1722-1729.
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备注/Memo
1,上海交通大学医学院附属新华医院儿童骨科（200092）；2，韩国首尔高丽大学附属九老医院骨科，E-mail：chentingsun@126.com