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后路全椎弓根螺钉系统治疗青少年特发性脊柱侧凸疗效分析

Analysis of posterior pedicle screw-only constructs in surgical treatment of adolescent idiopathic scoliosis with a minimum three-year follow-up

摘要:

目的 探讨采用单纯后路全椎弓根螺钉系统治疗青少年特发性脊柱侧凸(AIS)的疗效.方法 2002年4月至2006年7月,连续收治121例AIS患者,其中男性28例,女性93例;年龄10~20岁,平均15.5岁.全部患者采用后路全椎弓根螺钉系统治疗.手术前后在脊柱X线片上测量冠状位Cobb角,矢状面胸椎后凸和腰椎前凸角,最下端融合椎冠状面成角,锁骨角及双肩高度差.骶骨中垂线与融合下端椎、顶椎及C,中垂线平均距离,融合近端交界区后凸角,对以上指标进行对比分析并观察并发症发生情况.结果 平均融合(11.0±1.5)个椎体.冠状面平均矫正率近胸弯为41.8%,主胸弯为70.8%,胸腰.腰弯为74.0%;矢状面各指标无明显改变.主弯顶椎偏移及双肩平衡均得到良好恢复.术后随访36~54个月,未发现假关节形成,且无明显矫形丢失;1例患者出现附加现象,4例患者出现术后近胸弯失代偿,15例患者出现近端交界性后凸.结论 后路全椎弓根螺钉系统治疗AIS能获得良好的矫正率,并发症少,疗效满意.

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abstracts:

Objective To evaluate clinical outcomes of a group of adolescent idiopathic scoliosis ( AIS) patients undergoing posterior pedicle screw-only instrumentations. Methods Between April 2002 and July 2006,121 AIS patients (93 female and 28 male, average age at operation was 15.5 years which ranged from 10 to 20 years) received posterior pedicle screw-only instrumentation and fusion. All the patients were evaluated by the various-parameters measured in X-ray films before and after surgery, including Cobb angle on coronal plane, Cobb angle on sagittal plane, clavicle angle and shoulder height difference, lowest instrumented vertebrae (LIV) angulation, proximal junction kyphotic angle, the distances of central scaral vertical line (CSV!.) to the LIV,to the apical vertebra and to the C_7 plumb line respectively. Complications were followed. Results An average of (11.0 ± 1.5) levels was fused. An average coronal correction of proximal thoracic curve was 41. 8% , of thoracic curve was 70. 8% , of thoracolumbar/lumbar curves was 74. 0%. No significant change was found in sagittal alignment. Shoulder balance and apex vertebral to central sacral line were restored well. There were no pseudoarthroses and loss of correction during the follow-ups. One adding-on, 4 proximal thoracic decompensation and 15 proximal junction kyphosis were found during the follow-ups. Conclusion Posterior pedicle screw-only instrumentation and fusion has excellent radiographic and clinical results with minimal complications in the surgical treatment of AIS.

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作者: 李明 [1] 赵颖川 [1] 朱晓东 [1] 贺石生 [1] 王传锋 [1] 杨长伟 [1]
第一作者: 李明
期刊: 《中华外科杂志》2010年48卷6期 410-414页 MEDLINEISTICPKUCSCD
分类号: R6
栏目名称: 青少年特发性脊柱侧凸
DOI: 10.3760/cma.j.issn.0529-5815.2010.06.005
发布时间: 2010-06-08
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