选择性胸椎融合治疗脊柱侧凸合并脊髓空洞症

Selective thoracic fusion in the scoliosis associated with syringomyelia

目的评价选择性胸椎融合治疗脊柱侧凸并脊髓空洞症的效果。方法对2001年1月至2009年1月收治的93例脊柱侧凸并脊髓空洞症患者进行回顾性分析，其中行选择性胸椎融合且术后随访超过2年的患者共11例，男性3例，女性8例；年龄9～21岁，平均14．9岁。侧凸类型包括双弯9例，三弯2例。术前、术后及随访时行x线片检查，对侧凸类型、侧凸Cobb角、顶椎旋转度、顶椎偏距、侧凸柔韧性、躯干偏移进行测量和分析。结果术前胸腰凸或腰凸LenkeA型2例，LenkeB型7例，LenkeC型2例。手术前后胸凸Cobb角平均值分别为62．6°和19．0°，平均矫正率为69．6％；手术前后胸腰凸或腰凸Cobb角分别为36．1°和11．6°，自动矫正率为67．9％，随访时间24～48个月，平均29．5个月，胸凸矫正丢失率为6．8％。最终随访时有1例发生了冠状面躯干失平衡，有1例发生椎弓根螺钉螺帽脱出，行翻修手术，无神经系统并发症发生。结论选择性胸椎融合可用于脊柱侧凸并脊髓空洞症患者的手术治疗，这类患者的胸腰凸或腰凸具有与特发性脊柱侧凸类似的自发矫形能力，参照特发性脊柱侧凸的选择性融合标准可获得良好效果。

Objective To evaluate the surgical results of selective thoracic fusion （STF） for scoliosis associated with syringomyelia. Methods From January 2001 to January 2009, 93 cases of scoliosis associated with syringomyelia were retrospectively reviewed. There were 11 cases who underwent STF and were followed up more than 2 years, which included 8 female and 3 male, the mean age was 14. 9 years （9-21 years）. Curve type, coronal and sagittal Cobb angle, apical vertebral rotation apical vertebral translation, flexibility, trunk shift were recorded and analyzed. Results There were 9 double curves and 2 triple curves, the Lenke type of thoracolumbar/lumbar curve included Lenke A in 2 cases, Lenke B in 7 cases and Lenke C in 2 cases. The average coronal Cobb angle of thoracic curve before and after surgery were 62. 6° and 19. 0° respectively, and the average correction rate was 69.6%. The average coronal Cobb angle of thoracolumbar/lumbar curve before and after surgery were 36. 1° and 11.6° respectively, and the average spontaneous correction rate was 67.9%. The followed up time ranged from 24 to 48 months （ mean 29.5 months） , the average loss of correction rate was 6. 8%. Only one trunk decompensation was noted at final follow-up. Pedicle screw nut loosening occurred in one patient and this patient underwent revision surgery, no neurological complication was noted at final follow-up. Conclusions STF could be safely performed in scoliosis associated with syringomyelia. Thoracolumbar/lumbar curve in these patients has similar spontaneous correction ability compared with idiopathic scoliosis patients. The satisfactory result could be achieved according to the STF criteria for IS.