脊柱板-棍系统与钉棒系统在重度脊柱侧凸矫形中的应用及效果

Application of pedicle screw/rod instrumentation and plate-rod spinal system(PRSS) instrumentation system in the severe scoliosis

[目的]评价脊柱板-棍系统(plate-rod spinal system,PRSS)及钉棒系统治疗重度脊柱侧凸的疗效。[方法]2001～2007年本科收治25例重度脊柱侧凸患者,按矫形器械分为PRSS系统治疗组和钉棒系统治疗组。采用PRSS系统治疗12例,男7例,女5例;平均15.2岁;其中先天性脊柱侧弯1例,神经纤维瘤型脊柱侧弯1例,特发性脊柱侧弯10例。钉棒系统治疗13例,男9例,女4例;平均17.6岁;其中特发性脊柱侧弯6例(1例术前不全瘫),先天性脊柱侧弯3例,神经纤维瘤型脊柱侧弯3例,重度脊柱侧弯翻修术1例。两组病例采用的术式包括术前牵引后,前路松解联合后路矫形;前路松解联合后路矫形术;一期单纯后路矫形术和后路松解截骨矫形术。术后根据畸形矫正及并发症发生情况评估两种内固定系统的疗效。[结果]两组病例均顺利完成手术,无死亡及严重手术并发症出现。PRSS治疗组平均手术时间3.6h,术中平均出血量930m l,术后平均随访56.7个月,主侧弯Cobb角由术前平均98°(86°～135°),矫正至术后平均59°(32°～76°),矫正率平均57%,出现断棒3例,脱钩1例,皮肤破溃或皮下滑囊形成11例。钉棒系统治疗组平均手术时间4.6h,术中平均出血量1 420m l,术后平均随访7.8个月,主侧弯Cobb角由术前平均108°(93°～159°),术后矫正至平均54°(30°～105°),矫正率平均66.3%。矢状面后凸从术前平均116°(90°～155°)矫正至术后平均34°(20°～45°),发生肠系膜上动脉综合征1例,术后肋间神经痛1例,术后双下肢一过性麻木2例,一过性肌力减退1例。[结论]术前正确评估判断是前提;手术彻底松解是基础,椎弓根钉置入、矫形靠经验,准确操作及诱发电位监控是安全保障。PRSS系统操作简便、经济,与钉棒系统相比,矫正效果差,并发症较多。

[Objective]To evaluate the effects of pedicle screw/rod instrumentation and PRSS instrumentation system in the severe scoliosis patients.[Methods]Twenty-five patients with severe scoliosis were corrected by pedicle screw/rod instrumentation and PRSS instrumentation system,respectively.During 2001～2007,the 12 severe scoliosis patients,with 7 male and 5 female,mean 15.2 years（range,11～19 years） old,10 patients for idiopathic scoliosis,1 for congenital scoliosis,1 for neurofibroma with scoliosis,were corrected by PRSS instrumentation system.Thirteen severe scoliosis patients,with 9 male and 4 female,mean 17.6 years（range,4～25 years） old,6 patients for idiopathic scoliosis,3 for congenital scoliosis,3 for neurofibroma with scoliosis,1 for severe scoliosis revision,were corrected by pedicle screw/rod instrumentation within 2006～2007.[Results]In both groups,there were no severe complications during or after operation.In PRSS instrumentation system group,mean operative time was 3.6 h（range,2.8～5.1 h）,mean blood loss were 930 ml（range,860～2 100 ml）,mean follow-up time were 56.7 months（range,10～78 months）.The average Cobb angle in the coronal plane decreased from 98°（range,86°～35°） before operation to 59°（range,32°～76°） immediately after surgery.The correction rate was 57%.One case had rod rapture,3 cases had hook dislodgment,11 cases had dermal ulcer or bursitis.In pedicle screw/rod instrumentation group,mean operative time was 4.6 h（range,3.8～6.1 h）,mean blood loss were 1 420 ml（range,1 100～2 800 ml）,mean follow-up time was 7.8 months（range,1～18 months）.The average Cobb＇ s angle correction in the coronal plane decreased from 108°（range,93°～159°） before operation to 54°（range,30°～105°） immediately after surgery.The correction rate was 59%.The average kyphotic angle were 116°（range,90°～155°） before operation,decreased to an average of 34°（range,20°～45°） immediately after surgery.Paralysis was found in 1 case and function improved after operation,2 cases had Mesenteric syndrome,1 case had intercostal neuralgia,2 cases had transient paralysis of both lower limbs,1 case had transient muscle weakness.[Conclusion]1.It is important to evaluate carefully the patients before operation and to release completely and osteotomy during operation.SEP-MEP monitoring and hypotension control during operation are also important to achieve successful correction.2.Compared to pedicle screw/rod instrumentation system,PRSS instrumentation system is cheaper and easier to handle,but has lower degrees of correction and more complications.