肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合术中的应用

Application of rib strut grafting in anterior instrumentation and fusion for adolescent idiopathic scoliosis

目的:评价肋骨结构性支撑植骨在青少年特发性脊柱侧凸(AIS)前路矫形融合术中的应用效果。方法:回顾性分析术后随访时间超过1年的AIS病例35例,男4例,女31例;年龄12～17.5岁,平均14.6岁。侧凸类型包括PUMCⅠa型1例,Ⅰb型6例,Ⅰc型3例,Ⅱc1型1例,Ⅱd1型24例。采用前路三维矫形手术,融合3～7节椎体,平均4.4节。内固定器械包括CDH21例、Isola12例、TSRH1例、Moss Miami1例。全部病例均采用自体肋骨结构性支撑植骨。术前、术后及随访时摄脊柱X线片,测量冠状面及矢状面Cobb角,并观察植骨融合情况,有无假关节形成及螺钉松动、断钉、断棒等内置物并发症。结果:随访12～75个月,平均29个月,融合弯冠状面矫形率术后平均为76.5%,其中21例随访超过2年者末次随访时矫形丢失平均4.2°;固定融合节段冠状面矫形率术后平均为93.6%,随访超过2年者末次随访时丢失平均1.7°;固定融合节段矢状面Cobb角术前与术后比较无显著性差异(P=0.086),随访超过2年者末次随访时矫形丢失平均2.3°。13例胸腰段后凸患者术前后凸平均8.3°,术后矫正为前凸5.6°,1年随访时保持前凸4.2°。全部病例末次随访时均未见假关节形成和内置物并发症。结论:在AIS前路矫形融合手术中采用肋骨结构性支撑植骨融合率高,能获得并维持良好的冠状面及矢状面矫形,是一种可靠、有效的植骨方法。

Objective：To evaluate the outcomes of anterior spinal fusion（ASF） for adolescent idiopathic scoliosis（AIS） using rib strut grafting technique.Method：35 AIS cases received ASF with single solid rod instrumentations over 1 year follow-up were reviewed.There were 4 males and 31 females with an average age of 14.6 years,the average follow-up was 29 months （range,12-75 months）.The types of curve included PUMC Ⅰ a in 1, Ⅰ b in 6, Ⅰ c in 3, Ⅱ el in 1 and Ⅱ dl in 24.All of them underwent anterior thoracolumbar or lumbar fusion using rib strut grafting.The average fused vertebrae was 4.4 segments （range,3-7 segments ） .The coronal and sagittal Cobb＇s angles were measured on the standing anterioposterior and lateral radiographs before surgery,after surgery and at the follow-up.Result：The coronal correction rate of the fused curve was 76.5% after surgery with an average 4.2° loss of correction at the final follow-up.For the instrumented sagments,the coronal correction rate was 93.6% after surgery with an average 1.7° loss at the final follow-up, while no significant change was noted at the sagittal plane before and after surgery and the correction loss was 2.3° at the final follow-up.In 13 cases with thoraeolumbar kyphosis before surgery,the Cobb angle was corrected from 8.3° kyphosis to 5.6° lordosis after surgery,and 4.2° lordosis at one-year follow-up.No pseudarthroses or implant failures were observed at the final follow-up.Conclnsion：The appropriate rib strut grafting shows excellent results in achieving and maintaining the correction of the coronal and sagittal curvature with no pseudarthrosis and implant failure in the anterior correction of AIS.