特发性重度僵硬性脊柱侧凸的手术治疗

The operation treatment for severe and rigid idiopathic scoliosis

目的探讨特发性重度僵硬性脊柱侧凸的手术治疗效果.方法回顾性分析1999年6月至2003年6月手术治疗的特发性重度僵硬性脊柱侧凸.男9例,女15例,平均年龄17岁(12～20岁).术前站立位主侧凸冠状面Cobb角平均98°(80°～117°),仰卧位反向弯曲相上柔韧性平均20.8%(5%～29.5%).合并有矢状面畸形者15例.全部病例以北京协和医院分型原则进行手术融合.19例行前后路联合矫形术,5例行一期单纯后路矫形术.结果全部病例获随访,随访时间平均18个月(12 ～30个月).术后主侧凸冠状面角58°(32°～100°),主侧凸矫正率平均为41.0%(10.9%～61.0%).术后1例脱钩而行翻修术.1例钢丝断裂而无神经症状,给予严密观察.最后一次随访主侧凸冠状面角平均63°(31°～104°),矫正平均丢失5°(0°～10°).无假关节形成及失代偿发生.结论与椎体截骨术相比,前路松解加后路矫形内固定术及单纯后路矫形内固定术具有危险性小、出血少、感染率低等优点,对特发性重度僵硬性脊柱侧凸来说,是一种安全有效的治疗方法.适当矫形及恢复冠状面和矢状面平衡是手术治疗的关键.

Objective To discuss the operation treatment for the severe and rigid idiopathic scoliosis.Methods The clinical data of 24 patients with severe and rigid idiopathic scoliosis, 15 females and 9 males, with an average age of 17(12~20)who had undergone operations from June 1999 to June 2003 were analyzed retrospectively. The patients were classified according to PUMC operative classification systerm, including 16 cases of type Ia,2 cases of type Ib, 3 cases of type IIb2,and 1 case of types IIb1, IIc2, and IIc3 each. The average standing coronal Cobb angle was 98°(80°to 117°)and the average flexibility rate of the major curves was 20.8%(5% to 29.5%)before operation. Fifteen cases had sagittal deformities. Bone fusion was performed on all the cases according to the PUMC classification principles. 17 cases received anterior spinal release with posterior correction by two stages, and 2 cases by one stage. 5 cases received one-stage posterior correction. All the patients were followed up for 12~30 months (18 months on average). Results The mean standing coronal Cobb angle of the major curves was reduced to 58°(32°to 100°) after operation with a correction rate of 41.0%(10.9% to 61.0%). The results of sagittal plane correction were satisfying. The mean Cobb angle of the major curves at the final follow up was 63°(31°to 104°), and the mean lost was 5°(0°to 10°). One case had to undergo revision surgery because of hook displacement. One case had steel wire broken but without neurological symptoms and only needed observation. No pseudoarthrosis and decompensation occurred. Conclusion Compared with vertebral osteotomy for the correction of scoliosis, the anterior spinal release combined with posterior correction and simple posterior correction have the advantages of low risk, less blood loss, and low infection rate. They can be used effectively and safely for the correction of idiopathic severe and rigid idiopathic scoliosis. The key points for the surgical procedures are appropriate correction and recovery of the balances of the coronal and sagittal planes.