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经椎弓根截骨矫治成人特发性脊柱侧凸的临床疗效

The clinical outcomes of surgical treatment for adult idiopathic scoliosis using pedicle subtraction osteotomy

摘要:

目的 评价经椎弓根截骨术(PSO)矫治成人特发性脊柱侧凸的临床疗效.方法 回顾分析2001年7月至2007年11月共25例采用脊柱后路PSO治疗的成人特发性脊柱侧凸患者的临床资料.其中男性7例,女性18例;手术时年龄29~48岁,平均35岁.弯曲类型为胸腰双弯9例,胸腰/腰单弯16例.截骨部位均选择在顶椎,其中T11 1例,T12 7例,L1 11例,L2 6例.对比术前、术后及随访时脊柱站立位正侧位X线片判断矫形效果.结果 所有病例手术顺利完成,手术时间220~380 min,平均274 min;术中失血量1500~5000 ml,平均2328ml.腰弯/胸腰弯的侧凸Cobb角术前70°~121°,平均88°;术后矫正至35°~70°,平均43°;矫正率44%.腰弯/胸腰弯的后凸Cobb角术前50°~90°,平均63°;术后矫正至-40°~21°,平均10°;矫正率86%.矢状面的矫形效果明显优于冠状面.手术并发症包括发生神经根损伤3例,术后表现为根性疼痛;无脊髓损伤、迟发性瘫痪、感染和固定失败发生.所有病例随访2~4年,无明显矫形丢失,无躯干失代偿发生,腰背疼痛均得到满意的缓解,患者外观均获得明显改善.结论 PSO矫治成人特发性脊柱侧凸安全有效.

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abstracts:

Objective To evaluate the clinical outcomes of transpedicular lumbar wedge resection osteotomy in treating adult idiopathic scoliosis. Methods Twenty-five adult idiopathic scoliosis patients treated with transpedicular lumbar wedge resection osteotomy from July 2001 to November 2007 were included, among whom 18 were female and 7 were male. Nine of 25 were with double major curve in thoracic and thoracolumbar/lumbar spine, and 16 were with single curve in thoracolumbar/lumbar spine. The average age was 35 years (29-48 years) at operation. Osteotomy were performed at T11 , T12, L1 or L2. The motion evoked potential monitoring system and awaking test were used during surgery. The preoperative,postoperative immediately and latest standing posteroanterior and lateral radiographs were reviewed. Results All patients were operated successfully. The average operation time was 274 min (range, 220-380 min)and the average blood loss were 2328 ml (range, 1500-5000 ml). The average coronal Cobb angle of all patients in thoracolumbar/lumbar curves was 88° (range, 70°-121°) before operation, which was corrected to 43°(range, 35°-70°). The coronal correction rate was 44%. The average kyphosis angle of all in thoracolumbar/lumbar curves was 63° (range, 50°-90°) before operation, which was corrected to 10°(range, -40°-21°). The sagittal correction rate was 86%. Nerve root injury occurred in 3 of all patients who complained about postoperative radicular pain. No spine cord injury, delayed paralysis, infection and instrumentation failure were found. With a follow-up of 2-4 years, no correction loss or decompensation happened. The back pain existing before operation was relieved in large measure. The cosmetic appearance were all promoted significantly. Conclusions The transpedicular thoracolumbar/lumbar wedge osteotomy is efficient and safe in the correction of adult idiopathic scoliosis. The correction is much better on the sagittal plane than that on the coronal plane.

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作者: 张永刚 [1] 张国莹 [1] 张雪松 [1] 王征 [1] 毛克亚 [1] 王岩 [1]
第一作者: 张永刚
期刊: 《中华外科杂志》2010年48卷22期 1705-1708页 MEDLINEISTICPKUCSCD
分类号: R6
DOI: 10.3760/cma.j.issn.0529-5815.2010.22.008
发布时间: 2010-12-13
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