应用脊椎操纵器顶椎双侧去旋转技术治疗特发性脊柱侧凸的早期疗效

Preliminary outcome of three-dimensional correction on idiopathic scoliosis by bilateral apical vertebral derotation by vertebral column manipulation

目的评估应用脊椎操纵器(vertebral column manipulation,VCM)顶椎双侧去旋转技术治疗特发性脊柱侧凸(idiopathic scoliosis,IS)的早期疗效。方法 2011年2～9月使用VCM去旋转技术治疗IS患者17例(VCM组),其中男6例,女11例,平均年龄14.3岁;Lenke 1型10例,2型7例;术前主弯Cobb角平均57.5°。2010年7月～2011年2月采用旋棒技术治疗IS患者18例(旋棒组),男6例,女12例,年龄平均14.5岁;Lenke 1型10例,2型8例;术前主弯Cobb角平均58.1°。手术采用后路椎弓根螺钉固定、VCM矫形或旋棒技术矫形以及同种异体骨植骨融合。以主弯Cobb角矫正率、胸椎后凸角、腰椎前凸角及顶椎椎体旋转角(rotation angle sagittal,RAsag)矫正率评价矫形情况。结果所有患者成功完成手术,无严重并发症发生。VCM组Cobb角矫正率为(85.3±7.2)%,旋棒组为(79.4±11.4)%,差异无统计学意义(P>0.05)。矫形后胸椎后凸角及腰椎前凸角2组之间差别无统计学意义(P>0.05)。VCM组顶椎RAsag矫正率为(61.4±12.9)%,旋棒组为(26.1±20.6)%,差异有统计学意义(P<0.05)。VCM组随访8.7个月,旋棒组13.4个月,随访期间未见明显的失代偿和矫形度数丢失(P>0.05)。结论 VCM顶椎双侧去旋转技术是一种有效的IS矫形方法,三维矫形效果满意,去旋转矫形方面矫形效果明显。

Objective To evaluate the preliminary outcome of bilateral apical vertebral derotation by vertebral column manipulation（VCM） for the management of idiopathic scoliosis（IS）.Methods A total of 35 patients with IS undergoing posterior pedicle screw fixation,bilateral apical vertebral derotation by VCM or freehand derotation technique correction,and allograft fusion were included in this study.Of all patients,17 IS cases（6 males and 11 females） were included in the VCM group from February to September 2011 with an average age of 14.3 years old.IS presented with Lenke type 1（n=10）,2（n=7）.The average Cobb’s angle of main curve was 57.5°.The other 18 IS patients（6 men and 12 women） were included in the rod derotation group from July 2010 to February 2011 with an average age of 14.5 years old.IS presented with Lenke type 1（n=10）,2（n=8）.The average Cobb’s angle of main curve was 58.1°.After surgery,the Cobb’s angle of the main curve were evaluated,and the rotation angle sagittal（RAsag） were measured to assess the correction of rotation deformity.The correction was calculated as（preoperative value-postoperative value）/preoperative value ×100%.The sagittal corrected effect was assessed with thoracic kyphosis,and lumbar lordosis.Results All patients underwent this surgical protocol successfully without major complications.In the VCM group,the correction of the main curve Cobb’s angle was（85.3±7.2）%,and in the rod derotation group,the correction of the main curve Cobb’s angle was（79.4±11.4）%.No difference in correction of the main curve Cobb’s angle between the 2 groups was noted（P〉0.05）.Corrections of RAsag were（61.4±12.9）% in the VCM group and（26.1±20.6）% in the rod derotation group respectively,and had statistical significance between the 2 groups（P0.05）.Patients were followed up for an average of 8.7 months in the VCM group,and an average of 13.4 months in the rod derotation group showing no signifi cant loss of correction.Conclusion Bilateral apical vertebral derotation by VCM can manage coronal misalignment,recover spine sagittal alignment and rotational deformity of IS effectively.Moreover bilateral apical vertebral derotation by VCM can signally correct the rotational deformity.