杠杆力矫正法治疗重度脊柱侧弯早期疗效

Cantilever bending technique for treatment of severe and rigid scoliosis

目的评估后路杆杠力矫正法(cantilever bending technique)治疗重度(Cobb角≥70°)及僵硬(柔韧性≤30%)的脊柱侧凸畸形的治疗效果及临床应用价值。方法回顾性研究采用杆杠力矫正法治疗的重度且僵硬的脊柱侧凸畸形患者26例。根据患者的影像学数据、并发症发生情况及改良式脊柱侧凸研究会(Modifilied SRS Outcomes Instrumen)t病患满意度问卷(SRS-24)评估临床疗效及价值。结果脊柱侧凸的主弯(major curve)平均Cobb角为92.5°(70°-162°),柔韧性为13%(2%-29%),术后矫正率为60.9%(33.3%-81.4%),术前的冠状面失衡约为2.6cm,术后为0.9cm,手术并发脑脊液漏1例,血气胸3例。结论杆杠力矫正法治疗重度僵硬脊柱侧凸畸形的临床应用价值在于省略了前路脊柱松解,减少并发症发生率及提高患者的满意度。

Objective To assess the efficacy and clinical value of cantilever bending technique as a technique for correcting large(≥70°) and rigid(flexibility≤30%) scoliosis.Method From 2009 to 2010,a total of 26 consecutive patients undergoing cantilever bending technique for the management of severe and rigid scoliosis of any etiology(congenital,idiopathic,or neuromuscular) and followed up 1 month to 1 year were included.The radiographic studies,complications and patient satisfaction assessment utilizing the Modified Scoliosis Research Society Outcomes Instrument were used to assess outcomes.Results All patients underwent surgery safely.The average Cobb′s anger of the major curve was 92.5°(rang,70°-162°),and the flexibility was 13%(rang,2%-29%).The deformity correction was60.9%(rang,33.3%-81.4%).Coronal imbalance was 2.6cm before and 0.9cm after surgery.One case with cerebrospinal fluid leakage and two cases with hemopneumothoroax occurred in this group of patients.Satisfactory correction was achieved in all patients and without anterior release in all patients.Regardless of the etiology of their deformities,all patients were very satisfied with their surgical outcomes.Conclusion The cantilever bending technique is an effective procedure for the management of sever and rigid scoliosis regardless of etiology.The clinical value of the procedure is demonstrated by reduced need for anterior release,fewer complications,and high rates of patient satisfaction.