特发性脊柱侧凸后路矫形中尾侧椎应用椎弓根螺钉与椎板钩固定的效果比较

Comparison of pedicle screws versus laminar hooks in the distal segment of posterior correction for idiopathic scoliosis

目的:评价特发性脊柱侧凸矫形中,尾侧椎应用椎板钩和椎弓根螺钉固定的临床效果及安全性。方法:对收治的34例后路矫形内固定且随访1年以上的特发性脊柱侧凸(KingⅡA和Ⅲ型)患者,根据尾侧椎固定方式的不同,分为A组(椎板钩固定组)和B组(椎弓根螺钉固定组)。A组14例,男4例,女10例,平均年龄13.6岁(12～17岁)。B组20例,男6例,女14例,平均年龄14.1岁(13～17岁)。比较两组患者术前侧凸角度、矢状面曲度及矫正率、随诊丢失角度、手术时间、出血量、融合节段等方面的差异。结果:两组患者术前侧凸角度、矢状面曲度及矫正率、手术时间、手术出血量没有明显的统计学差异。A组侧凸角度丢失大于B组(P<0.05),且A组中有3例在融合节段与下方非融合节段交界处出现后凸。A组平均融合11个节段,B组平均为10个节段。结论:在特发性脊柱侧凸后路矫形中,以椎弓根螺钉替代椎板钩内固定尾侧椎可较好地维持术后矫形效果,预防融合节段与未融合节段交界处后凸,保留更多的远端活动节段并具有较好的安全性。

Objective:To evaluate the effectiveness and safety of lumbar pedicle screws versus laminar hooks in the distal segment of posterior correction for idiopathic scoliosis.Method:From February 1998 to October 2002,34 patients with idiopathic scoliosis(King typeⅡA and Ⅲ) who underwent posterior correction and were followed more than one year were analyzed prospectively.All patients were divided into group A(laminar hook group) and group B(pedicle screw group) based on the anchor type in the distal segment.In group A,there were 4 males and 10 females with an average age of 13.6 years(12 to 17 years).In group B,there were 6 males and 14 females with an average age 14.1 years(13 to 17 years).Preoperative Cobb angle,saggital contour,correction rate,correction loss,operation time,amount of blood loss and fusion levels were compared between group A and B.Result:No statistically difference were noted in preoperative Cobb angle,correction rate,operation time and amount of blood loss between group A and B.In group A,more correction loss was found and 3 cases developed kyphosis at the junction between fused segments and nonfused segments.Fusion segments averaged 11 in group A with 10 in group B.Conclusion:In posterior correction for idiopathic scoliosis,pedicle screws using in the distal segment can safely offer better maintenance of curve correction and prevention of kyphosis at the junction of fused segments and nonfused segments with a shorter fusion.