一期后路全椎弓根螺钉矫形治疗成人僵硬性脊柱侧凸

Treatment of rigid adult scoliosis by one-stage posterior fixation with all pedicle screw technique

目的回顾分析一期后路全椎弓根螺钉矫形治疗成人僵硬性脊柱侧凸的疗效。方法2001年1月～2007年5月,通过一期后路全椎弓根螺钉矫形治疗了19例成人僵硬性脊柱侧凸患者。术前冠状面主凸Cobb角为59.2°(43°～90°),侧屈位平均矫正率为25%。术后平均随访18个月(10～43个月),通过影像学检查对手术矫形效果及躯干平衡情况进行分析,末次随访时进行患者主观疗效评价。结果所有患者术后外观明显改善。总体冠状面主凸平均Cobb角矫正率为45.9%。末次随访冠状面Cobb角平均丢失3.1°。冠状面平衡由术前平均2.8cm矫正为术后平均0.8cm。15例患者对手术表示满意。结论对于成人僵硬性脊柱侧凸,一期后路全椎弓根螺钉矫形技术可以获得较高的冠状面矫正率,重建躯干平衡,患者满意度较高,并发症较少。

Objective To evaluate the efficacy of one-stage posterior fixation with all pedicle screw technique in the treatment of rigid adult scoliosis. Methods Nineteen rigid adult scoliosis patients including adult idiopathic and degenerative scoliosis were all surgically treated by posterior pedicle screw fixation from January 2001 to May 2007. Preoperative mean Cobb＇ s angle of major curves on the coronal plane was 59.2°（43° -90°） , and the mean correction rate on side-bending film was 25%. Mean period of follow-up was 18 months （10 -43 months）. Preoperative and postoperative Cobb＇ s angles of the coronal plane and sagittal plane and coronal trunk balance were measured. The subjective efficacy was assessed by questionnaire. Results Clinical appearance of all the patients improved significantly. Mean correction of major curves of the coronal plane was 45.9%. Mean lost of correction on the coronal plane at the last follow-up was 3.1°, and coronal trunk balance was corrected from 2.8 cm to 0.8 cm. Questionnaire in the follow-up showed that 78.8% patienis were satisfied with operation resuits. Urethral infection occurred in 2 patients and ileuses in 3 patients, and 2 cases had adjacent degeneration and 1 with pseudarthrosis. Conclusion Radiological assessment and patients＇ self-evaluation showed that all pedicle screw fixation could gain good correction and trunk balance in the treatment of adult scoliosis. And patients are more satisfied and have less complications.