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青少年特发性脊柱侧凸远端融合椎的选择

Selection of distal fusion levels in the surgical management of thoracolumbar/lumbar adolescent idiopathic scoliosis

摘要:

目的 论证一种新的青少年特发性脊柱侧凸(AIS)患者远端融合椎的选择方法,评估其临床疗效.方法 运用新的远端融合椎选择标准,前瞻性研究2005年7月至2008年9月接受诊治且符合人组条件的AIS患者31例,平均年龄15.6岁(12~19岁),平均随访27.5个月(12~49个月).观察术前、术后以及末次随访时冠状面的侧凸Cobb角、远端融合椎倾斜角、远端融合椎椎间角、C_7椎体中心至骶骨中垂线的距离(C_7-CSVL)、胸后凸、腰前凸等变化,并进行统计学分析.结果 术前、术后即刻冠状面胸弯Cobb角分别为(42±17)°和(12±7)°,侧凸矫形率平均70.6%;冠状面腰弯Cobb角分别为(44±7)°和(9±4)°,侧凸矫形率平均80.2%;C_7-CSVL分别为(13±8)和(9±7)mm,差异有统计学意义(P<0.05);远端融合椎倾斜角分别为(20.8±5.7)°和(1.5±3.1)°,术后较术前明显改善(P=0.000).末次随访时患者胸弯Cobb角为(14±8)°,腰弯cobb角为(9±5)°,C_7-CSVL为(6±5)mm,与术前比较差异均有统计学意义(P<0.05).末次随访远端融合椎倾斜角为(0.8±3.7)°,与术后即刻相比差异无统计学意义(P>0.05).结论 运用远端椎旋转度数和远端椎柔韧性选择远端融合椎的方法手术治疗AIS是安全、有效的.

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abstracts:

Objective To investigate the efficacy and safety of a new method which determines the exact distal fusion level in the treatment of adolescent idiopathic scoliosis (AIS) with posterior pedicle screw fixation and to assess its clinical outcome. Methods This prospective clinical study analyzed 31 AIS patients who met the inclusion criteria enrolled from July 2005 to September 2008. Based on the principle of our new criteria for selection of distal fusion level of AIS, all patients had posterior spinal fusion and instrumentation with pedicle screws. Cobb angle of the curve,tilt angle of the LIV, intervertebral angle and trunk shift were measured and analyzed. Results Preoperative (42 ± 17)° of thoracic curve was corrected to (12±7)°, with a curve correction of 70. 6%. Preoperative (44 ±7)° of lumbar curve was corrected to ( 9 ± 4) °, with a curve correction of 80. 2%. The trunk shift were significantly improved from (13 ± 8 ) mm to (9 ±7) mm before and after surgery respectively (P <0. 05). The tilt angles of the LIV before and after surgery were (20. 8 ± 5. 7) ° and (1.5 ± 3. 1) ° respectively. The thoracic Cobb angle was (14 ± 8) ° and the lumbar Cobb angle was (9 ±5) ° at latest follow up. The changes were of significance in the tilt angle of the LIV after surgery compared with that before surgery (P = 0. 000). This angle averaged (0. 8 ± 3. 7) ° at final follow up, but the change was not significant compared with that after surgery(P >0. 05). Conclusion This is an effective method with the advantage of shortening the fusion level, reserving the distal motion segments and easing segmental degeneration adjacent to the fusion area.

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作者: 沈建雄 [1] 梁锦前 [1] 邱贵兴 [1] 王以朋 [1]
第一作者: 沈建雄
期刊: 《中华外科杂志》2010年48卷6期 415-418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.0529-5815.2010.06.006
发布时间: 2010-06-08
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