垂直悬吊牵引像在重度脊柱侧凸矫形中的应用

Evaluation of traction radiography of predicting correction of severe and rigid scoliosis

目的分析悬吊牵引像在脊柱侧凸矫形中预测上、下固定椎的作用。方法选择2004年7月至2008年7月北京协和医院骨科收治的胸椎侧凸畸形患者27例,男15例,女12例,年龄11～21岁,平均15.5岁。所有患者均采用后路脊柱侧凸矫形植骨融合、钉钩混合固定,随访6～36个月,平均14.7个月。采用标准方法测量术前脊柱正侧位悬吊牵引像,术后及随访正位像的Cobb角、顶椎偏距、悬吊稳定椎等,测量所得结果进行统计学分析。结果 (1)术后胸弯平均Cobb角为43.8°,术后随访平均Cobb角为51.1°,较术前(平均Cobb角84.6°)明显改善(P<0.01),平均矫正率为48.2%;(2)悬吊像胸弯Cobb角与术后胸弯Cobb角呈正相关(P<0.01);(3)悬吊像顶椎偏距、术后胸弯顶椎偏距与术前顶椎偏距有显著差异(P<0.01);(4)悬吊像下平分椎倾斜度与术前站立位下固定椎无显著差异(P>0.05),与术后及随访的下固定椎倾斜度有显著差异(P<0.01);(5)悬吊像上平分椎倾斜度与术前站立位上固定椎、术后及随访的上固定椎倾斜度有显著差异(P<0.01)。结论选择悬吊牵引像的稳定椎作为脊柱侧凸矫形中上、下固定椎,术后平衡效果良好。

Objective To determine how to select upper instrumented vertebrae（UIV） and lower instrumented vertebrae （LIV） in correction of severe and rigid scoliosis.Methods The utility of fulcrum bending,standing bending and traction radiography was evaluated in 27 patients with scoliosis who were aged 11-21 years and treated with the third multiple hook-screw and rod instrumentation system,such as TSRH,CD-Horizon,Isola,USS.Results①The mean Cobb angle of thoracic curves on the preoperative anterioposterior radiograph made with patient standing was 84.6 degrees, and the mean Cobb angle after surgery was 43.8 degrees,there was a significant difference（P〈0.01）.The mean correction rate was 48.2%.②In thoracic curves,the postoperative Cobb angle was highly correlated with the preoperative Cobb angle in traction film（r=0.697）.③There was a significant difference in apical vertebra translation（AVT） between the traction radiography and the postoperative radiography（P〈0.01）.④There was a significant difference between the mean inclination angle of UIV on the traction radiograph and that on the pre-and post-operative radiograph（P〈0.01）.⑤The mean inclination angle of LIV between the traction radiography and the post-operative radiography was statistically different（P〈0.01）,but there was no difference between the traction radiography and the pre-operative radiography （P〉0.05）.Conclusion The traction radiograph can be chosen as a predictive method of UIV and LIV in the patients who had segmental spinal instrumentation for correction of severe rigid scoliosis.