后路凸凹侧双棒同步矫形在青少年特发性脊柱侧凸矫治中的应用

Treatment of adolescent idiopathic scoliosis with posterior simultaneous correction by bilateral corrective rod on the convex and concave sides

目的探讨后路凸凹双侧矫形棒同步矫形技术在青少年特发性脊柱侧凸（AIS）外科矫治中的应用价值及疗效。方法2006年2月至2008年8月采用后路凸凹侧双棒同步矫形技术治疗AIS48例，其中男性16例，女性32例；年龄11～24岁，平均17．1岁。Lenke分型：Ⅰ型17例、Ⅱ型9例、Ⅲ型14例、Ⅳ型8例。行选择性胸弯融合27例，非选择性融合21例。观测手术前后冠状Cobb角、顶椎偏距、顶椎旋转、躯干偏移、尾端融合椎旋转、倾斜角、椎问角、矢状面平衡变化，评价侧凸矫正效果及脊柱平衡状况。结果术后随访12～27个月，平均15．1个月。选择性融合患者末次随访胸、腰弯Cobb角平均矫正率分别为（76±11）％、（72±9）％。非选择性融合术患者末次随访胸、腰弯Cobb角平均矫正率分别为（74±15）％、（69±9）％。所有病例尾侧保留脊柱活动节段平均4．4个。1例因术中定位错误发生近端交界性后凸行翻修术。其余病例末次随访无脊柱失代偿，无假关节形成、神经损伤等并发症。结论应用后路凸凹双侧矫形棒同步矫形治疗AIS，有助于提高矫形效果，重建和维持脊柱平衡，减少尾侧融合节段。

Objective To evaluate the efficacy and clinical value of the strategy of posterior simultaneous correction by bilateral corrective rod on the convex and concave sides in the treatment of adolescent idiopathic scoliosis （AIS）. Methods From February 2006 to August 2008, posterior fusion was performed to 48 AIS patients. There were 16 males and 32 females, with an average age at the time of surgery of 17. 1 years. Lenke Type Ⅰwas found in 17 cases, Type Ⅱ in 9, Type Ⅲin 14 and Type Ⅳin 8. There were 27 patients used selective posterior fusion in thoracic, 21 cases without selective fusion. Observation index ： the Cobb angle on coronal plane, translation and rotation of apical vertebrae, the coronal balance, the Cobb angle on sagittal plane, obliquity between lowest instrumented vertebrae （LIV） and the pelvis, intervertebral angle and rotation of the LIV. The patients were followed up at an average time of 15.1 months （12-27 months）. Results In the 27 cases with selective fusion, thoracic coronal Cobb angle was （17 ± 8 ） °after the operation, with an average correction rate of （76 ± 11 ）% at final follow up. The lumbar Cobb angle was （13 ± 7 ）° after the operation, with an average correction rate of （72 ± 9 ）% at final follow up. In the 21 cases without selective fusion, the thoracic Cobb angle was（20 ±7） °after the operation, with an average correction rate of （74 ± 15 ）% at final follow up. The lumbar Cobb angle was （16 ± 8 ） °after the operation, with an average correction rate of （ 69 ± 9 ） % at final follow up. The average number of vertebrae retained below LIV was 4.4. There was 1 ease developing thoracolumbar kyphosis. During the follow up, there were no major complication of neurological injury, no pseudarthrosis and no spine decompensation. Conclusion Posterior bilateral segmental pedicle screw simultaneous correction technique as a technique for correcting thoracic and lumbar curves scoliosis can improve the treatment of idiopathic seoliosis with fewer vertebral fusion and complications.