前后路Ⅰ期手术治疗重度僵硬性青少年特发性脊柱侧弯

Treatment of severe and rigid adolescent idiopathic scoliosis with one-staged surgical operation combined anterior and posterior instrumentation

目的评价前后路Ⅰ期手术治疗重度僵硬性青少年特发性脊柱侧弯的临床疗效，探讨其手术适应证及手术操作要点。方法回顾性分析2002年1月至2007年6月本院应用前后路Ⅰ期手术治疗21例重度僵硬性青少年特发性脊柱侧弯患儿的临床资料，年龄8～16岁，平均13．8岁。结果7例行Ⅰ期胸腔镜前路松解联合后路矫形手术，末次随访主侧弯冠状面Cobb角平均矫正率为70．3％；14例行Ⅰ期传统开放前路松解、截骨、骨骺阻滞联合后路矫形手术，末次随访主侧弯冠状面Cobb角平均矫正率为67．2％。末次随访未发现椎弓根螺钉松动、断裂、曲轴现象、平背畸形、假关节形成、肺功能下降等并发症。患儿外观畸形改善或矫正。结论通过术前选择适宜的病例，术中严格操作，前后路Ⅰ期手术治疗重度僵硬性青少年特发性脊柱侧弯可取得良好的临床疗效，并可减少手术相关并发症，缩短住院时间及减少医疗费用。

Objective To study the clinical therapeutic effect of severe and rigid adolescent idio- pathic scoliosis（AIS） treated with one-staged surgical operation by anterior and posterior combined approach, and explore the indications and key points of manual operation skills. Methods Twenty-one cases of severe and rigid AIS （ranging from 8 to 16 years, with the mean age of 13.8 years） treated in our department from Jan 2002 to Jun 2007 were retrospectively analyzed. There were 7 cases underwent anterior release with thoracoscopic surgery and 14 cases with traditional surgery. Results The average corrective rates of Cobb angle of the coronal plane in the main lateral curvature of 7 cases and 14 cases were 70. 3% and 67. 2% respectively. There were no loose or fracture of pedicle screws, crankshaft phenomenon, flatback syndrome, pseudoarthroses or decline of lung function at last followup. The deformity of patients was improved or corrected. Conclusions We can gain a good clinical efficacy of the treatment of severe and rigid AIS by selecting appropriate cases pre-operatively and strictly operating intra-operatively, thus less surgery-related complications, shorter length of hospital stay and less medical costs will be achieved.