后路交叉置钉技术在青少年脊柱侧凸治疗中的应用

上海交通大学附属第六人民医院(上海市,200433)

青少年; 脊柱侧凸; 外科手术; 随访研究

Application of bilateral interval pedicle screwing for adolescent scoliosis patients.
Zhang Yan, Chen Bochang, Bao Kun.

Department of Orthopedics,Sixth People's Hospital,Shanghai Jiaotong University,Shanghai 200233,China. Corresponding author: Chen Bochang,Email: orthopedicchen@12 com

Adolescent; Scoliosis; Surgical Procedures,Operative; Follow-Up Study

DOI: 10.3969/j.issn.1671— 635 201 0 012

备注

目的 探讨后路交叉置钉技术对于治疗青少年脊柱侧凸的临床疗效。 方法 2010年1月至2014年1月,68例青少年脊柱侧凸病例,男10例,女58例,年龄11~16岁,平均1 5岁; 其中4例为神经肌肉型脊柱侧凸,其余为特发性脊柱侧凸; 术前冠状面主弯Cobb角平均5 2°,胸椎(T5~T12)后凸角度平均1 7°,手术方法为后路交叉置入椎弓根螺钉对脊柱侧凸进行矫正,对术后Cobb角、主弯Cobb角矫正率结果进行评价。 结果 术后随访12 ~ 40个月,平均2 5个月。术后主弯Cobb角矫正到1 5°,与术前比较有差异(t= 705,P<0.01),末次随访时平均20.2°,与术后比无差异(t= 053,P>0.05)。胸椎(T5~T12)后凸角术后平均2 8°,末次随访时平均2 2°,术前与术后、术后与末次随访相比较均无差异(P>0.05)。术后主弯Cobb角矫正率为70.5%,而末次随访时虽然主弯矫正率(6 4%)有一定丢失,但和术后比较无差异(t=0.126,P>0.05)。术后无患者出现脊髓或神经根损伤。末次随访时无内固定松动及断钉断棒,植骨融合牢固,均未出现明显的矫正丢失。 结论 对于青少年脊柱侧凸后路手术矫正,采用交叉置钉技术是一项值得推广的低费用、高安全的脊柱侧凸矫正技术。
Objective To explore the clinical efficacy of bilateral interval pedicle screw placement for adolescent scoliosis. Methods A total of 68 patients(10 boys and 58 girls)with adolescent scoliosis underwent posterior fusion using bilateral interval pedicle screw placement. Their mean age was 1 5 years. The preoperative angles of thoracic coronal and sagittal Cobb were 56 ° and 17°. The variables of main sagittal and coronal Cobb angles at the immediate postoperative and the last follow-up,curve correction rate were measured and the clinical outcomes analyzed. Results The mean follow-up period was 2 5 months. And the mean immediate postoperative and last follow-up main thoracic coronal Cobb angle were 1 5 ° and 20.2 °.No statistically significant differences existed between preoperative and immediate postoperative(P<0.01),but not between immediate postoperative and last follow-up(P>0.05).The mean thoracic sagittal Cobb angle improved from 1 7 °preoperatively to 2 8 ° immediate postoperatively. However,the change had no significant difference(P>0.05).The mean immediate curve correction rate of 70.5% differed not from that of the last follow-up(P>0.05).At the last follow-up,bone fusion was achieved in all patients.No instrumentation-related complications were noted. Conclusion Bilateral interval pedicle screwing is safe and efficacious for adolescent scoliosis.