广泛后路松解三维矫形治疗重度特发性脊柱侧凸

Treatment of severe idiopathic scoliosis with wide posterior spinal release and 3D spinal correction

目的:探讨广泛后路松解三维矫形对重度特发性脊柱侧凸的治疗效果。方法:2002年3月至2005年9月我院收治的有完整资料的重度特发性脊柱侧凸患者42例,根据不同手术方法将患者分为两组:A组(前路松解后路矫形)20例,男3例,女17例;年龄12～20岁,平均15.5岁;Lenke1型12例,2型2例,3型3例,5型3例。B组(后路脊柱松解三维矫形)22例,男3例,女19例;年龄12～26岁,平均15岁;Lenke1型13例,2型2例,3型4例,5型3例。比较两组间手术前、后及末次随访时Cobb角、手术时间、术中出血量、住院费用和SRS-22评分的差异。结果:A组主弯Cobb角由83.6°±7.6°矫正到21.4°±5.4°,矫正率为72.4%±5.1%;B组由85.4°±11.5°矫正到22.0°±5.4°,矫正率为74.1%±5.2%,两组间比较无统计学差异(P>0.05)。A组的手术时间、术中出血量、住院费用及SRS-22评分分别为303.9±28.9min、1379.5±236.8ml、92246.5±9784.9$及17.4±0.24分;B组分别为241.0±20.8min、965.5±193.1ml、77725.1±8917.8$及19.65±0.20分,两组间差异有显著性(P<0.05)。两组均无曲轴现象、假关节形成及失代偿发生。结论:广泛后路脊柱松解三维矫形对重度特发性脊柱侧凸的矫正效果满意,具有手术风险小、手术时间短、出血量少、住院费用相对低等优点。

Objective：To study the effect of treatment of severe and rigid idiopathic scoliosis with wide posterior release and third-generation 3D-spinal instrumentation.Method：The clinical data of 42 patients with severe and rigid idiopathic scoliosis undergoing operations in our hospital from March 2002 to October 2005 were analyzed retrospectively.The patients were classified into two groups according to different operative procedures.In group A（anterior spinal release and posterior correction）,there were 20 cases,17 females and 3 males with a mean age of 15.5 years （range,13 to 20 years ）.According to the Lenke surgical classification of AIS,12 cases were in type 1,2 cases in type 2,3 cases in type 3,3 cases in type 5.In group B （wide posterior release and 3D-intrumentation correction）,there were 22 cases,19 females and 3 males with the mean age of 15 years （range,12 to 26 years）.According to the Lnke surgical classification of AIS,13 cases were in type 1,2 cases in type 2,4 cases in type 3,3 cases in type 5.The pre- and post-operative and final follow-up standing coronal Cobb angle,operation time,blood loss vlumn,hospital duration,treatment cost and SRS-22 outcome score were analyzed comparatively.Result：In group A,the primary curve Cobb angle correction was from 83.6°±7.6° to 21.4°±5.4°,the correction rate was 72.4%±5.1%;In group B,the primary curve Cobb angle correction was from 85.4°±11.5° to 22.0°±5.4°,the correction rate was 74.1%±5.2%.There was no statistical significance between two groups （P〉0.05）,but the operation time,the blood loss volumn,the treatment cost and the SRS-22 outcome score between 2 groups demonstrated a statistical significance （P〈 0.05）.All patients in two groups were free from the crankshaft phenomenon,pseudoarticulation formation and postoperative decompensation.Conclusion：The wide posterior release plus 3D-intrument correction has the advantages of low risks,less blood loss,low surgical expense and less complications related to anterior release.