脊柱侧弯畸形的外科解剖及组织病理探讨

A Survey of the Anatomy and Morphologyof Paravertebral Soft Tissues in Scoliosis

为探索脊柱侧弯，尤其特发性侧弯的发病原因，作者对侧弯脊柱主弧两侧的软组织做了外科解剖及组织病理探讨，发现主弧凹侧的各层软组织均有挛缩现象并产生张力，光镜及电镜下观察其组织相，亦证实均有明显变性，而主弧凸侧的各层软组织只有轻度萎缩变性，从而证实侧弯的脊柱凹侧软组织变性挛缩成为脊柱侧弯畸形发展的重要因素，也是使脊柱侧弯畸形难以矫正的重要因素。作者在矫正脊柱侧弯畸形时，先将侧弯主弧凹侧变性挛缩的软组织松解，消除因其张力而产生之弓弦效应，皆能取得矫正脊柱侧弯的良好效果。作者在上述认识指导下采用凹侧松解及合页式石膏衫矫形方法治疗的一组脊柱侧弯患者３８例，治疗时平均年龄１４．６岁，随诊时间平均５．２年，随诊时特发性侧弯患者之最大矫正率为９８．２％，最小矫正率６８．３％，先大性侧弯最大矫正率为７７．９％，最小矫正率为６８．３％，全组患者无神经系统合并症发生。

AbstractBroken of the rod or wire and displacement of thehook and rod are usually seen in the treateint of scoliosisby using Iuque or Harrington rod instrumentation. Theauthors found that the reasons of these complicationswere caused mainly by the bow-string effect arisen fromthe contracted soft tissues on the concave side of the sco-liotic spine, The authors also found that the intercostaltissues of the proximal segments of the ribs, Ligamentsand capsules around the heads , necks and tubercles ofthe ribs, Ligaments and muscles of intertransversarium,capsules of interarticular facets,fascia lumbodorsalis andthe fascia of the musculus quadratus Iumborum were allcontracted.The section slides of these soft tissues wereinspected under the ligh and electronic microscopes andtheir degenerative changes and contractures were gener-ally seen. Although there was no marked degenerationor contracture in the muscles seen by bared eyes , therewere definite degenerative changes seen in the slides un-der both light and electronic micrOscopes, So degeneratIon and contrac ture of the paravertebral soft t issues inthe concave side are the main factors of the formation ofbow-string effect and the development of the deformityof scoliosis;Lowever , they are also the main factors ofmaking the correction of scoliosis more difficult. Theauthours’ experience is that to release the degenerativeandcontracted soft tissues in the concave side of the sco-liotic spine is very important in order to correct the scoli-otic spine more satisfactorily and safely.