摘要目的 比较体内撑开技术与传统前路松解后路矫形治疗重度僵硬性脊柱侧凸的疗效.方法 回顾性分析2008年4月至2013年5月手术治疗的40例重度僵硬性脊柱侧凸患者病历资料,根据是否采用体内撑开技术分为:体内撑开组20例,采用前路松解体内撑开、二期后路矫形,男5例,女15例,年龄(17.5±2.8)岁,其中特发性脊柱侧凸16例,神经肌源性脊柱侧凸4例;传统手术组20例,采用传统的前路松解后路矫形,男4例,女16例,年龄(17.2±2.6)岁,其中特发性脊柱侧凸17例,神经肌源性脊柱侧凸3例.比较体内撑开组和传统手术组的手术时间、出血量、主弯Cobb角、矢状面后凸角、冠状面及矢状面躯干偏移以评价疗效.结果 体内撑开组一期手术时间长于传统手术组,二期后路矫形时间短于传统手术组,出血量明显少于传统手术组;两组总体手术时间及出血量的差异无统计学意义.40例均获得随访,随访24～36个月,平均(28.1±5.7)个月,传统手术组和体内撑开组术前主弯Cobb角的差异无统计学意义;术后及末次随访,传统手术组主弯Cobb角明显大于体内撑开组,体内撑开组主弯矫正率73.7％,明显优于传统手术组(49.8％).传统手术组1例在后路矫形上棒时体感诱发电位波幅下降,取下矫形棒后恢复,加大矫形棒弯度后重新上棒,顺利完成手术;体内撑开组1例在撑开4.5 cm时出现体感诱发电位波幅下降,缩短撑开距离后恢复.两组各有2例于前路松解后出现肺不张,经呼吸功能锻炼后成功复张.传统手术组2例、体内撑开组1例出现顶椎区螺钉穿透椎弓根内侧皮质2～4 mm.体内撑开组2例在一期手术后出现远端代偿弯凹侧疼痛,经对症处理后缓解.结论 体内撑开技术可提高重度僵硬性脊柱侧凸的矫正率,不会显著增加手术时间、失血量及并发症发生率.

abstractsObjective To compare clinical results between internal distraction and traditional anterior release and posterior correction in the treatment of severe and rigid scoliosis.Methods 40 cases with severe and rigid scoliosis who had surgery from April 2008 to May 2013 were retrospectively analyzed.According to whether internal dis-traction was applied.They were divided into internal distraction group and traditional group.In internal distraction group,anterior release,internal distraction and staged posterior correction was applied.There were 5 males and 15 females in internal distraction group with an average age of 17.5±2.8,among were 16 cases of idiopathic scoliosis and 4 cases of neuromuscular scoliosis.In traditional group,traditional anterior release and posterior correction was performed.There were 4 males and 16 females in traditional group with an average age of 17.2±2.6,among them there were 17 cases of idiopathic scoliosis and 3 cases of neuromuscular scoliosis.Operation time,estimated blood loss,Cobb angle of major curve,kyphosis angle,coronal trunk shift,and sagittal vertical axis were compared between two groups.Results The time of first surgery in internal distraction group was longer than that of traditional group,but no significant increment in estimated blood loss was found.The time of posterior correction surgery in internal distraction group was shorter than that of traditional group,and estimated blood loss in internal distraction group was also less than that of traditional group.The follow-up duration averaged (28.1 ±5.7) months (24-36 months).After surgery and at final follow-up,Cobb angle of major curve in traditional group was much bigger than that of internal distraction group.The correction rate of major curve in internal distraction group averaged 73.7％.The decline of wave amplitude of somatosensory evoked potential (SEP) was found in one patient in traditional group when rods were connected to screws in posterior correction surgery.The rods were removed immediately,and SEP amplitude was restored.The rods were bent more and refixed,and the surgery was completed without alert.The decline of wave amplirude of SEP was found in 1 patient in internal distraction group when distraction was applied to 4.5 cm.The distraction was released and SEP amplitude was restored.Atelectasis after anterior release was found in 2 patients in traditional group and internal distraction group respectively,and it recovered after respiratory exercise.Medial breach 2-4 mm around the apical region was found in 2 patients in traditional group and 1 patient in internal distraction group.2 patients in internal distraction group had pain in concave side in distal compensative curve after the first surgery.It was considered as soft-tissue injury resulting from internal distraction,and resolved after treatment.There no significant difference in complication rate between 2 groups.Conclusion Internal distraction,which can improved the correction rate of severe and rigid scoliosis,but not increased operation time,estimated blood loss,and complication rate,is a safe and reliable technique.