后路选择性内固定矫形治疗青少年特发性脊柱侧凸

Treatment of adolescent idiopathic scoliosis with posterior selective-segment instrumentation

目的评价经后路选择性关键椎体内固定矫形治疗青少年特发性脊柱侧凸(AIS)的临床疗效,探讨其手术适应证。方法经后路选择性关键椎体内固定矫形治疗的131例青少年AIS患者,术前均进行详细的临床和影像学检查评估,按影像学资料确定主侧凸顶椎、端椎、中立椎、稳定椎等关键椎体,并拟定关键椎体椎弓根螺钉内固定。结果主侧凸Cobb角由术前的平均51.3°±12.9°矫正至术后的平均8.9°±4.5°。131例均获得随访,时间8～52个月,末次随访时主侧凸Cobb角平均丢失4.6°±1.2°,椎弓根螺钉松动1例,未发现椎弓根螺钉及棒的断裂。结论经后路选择性关键椎体内固定矫形治疗青少年AIS可取得良好的临床疗效,减少患者医疗费用,符合我国实际国情,但术前应做好适应证选择。

Objective To study the clinical result of adolescent idiopathic scoliosis （AIS） treated with posterior selective-segment instrumentation, and to explore the surgical indications. Methods 131 cases of AIS treated in our department with posterior selective-segment instrumentation were retrospectively analyzed. There was a detailed clinical and imaging examination assessment to each case preoperatively. Vertex vertebrae, end vertebrae, neutral vertebrae, stable vertebrae of the major curve and the fixed segments were assessed and prepared by preoperative imaging examination. Results The major curve was restored from preoperative average 51.3 °± 12. 9° to postoperative average 8.9°±4. 5°. The follow-up was from 8 to 52 months for all 131 cases. Average 4. 6°± 1.2° of major curve was lost, loosening of pedicle screws was found in one case, but there was no fracture of screw-rod at last follow-up. Conclusions It could reduce the costs and provides good clinical efficacy of AIS treated with posterior selective-segment instrumentation through selected appropriate cases preoperative, and it meets to the actual condition of China.