椎弓根螺钉治疗青少年特发性脊柱侧凸的手术疗效

Outcomes of Posterior Pedicle Screw Constructs on Adolescent Idiopathic Scoliosis

目的:探讨后路椎弓根螺钉治疗青少年特发性脊柱侧凸(AIS)的临床疗效。方法:2006年3月至2009年4月,连续收治青少年特发性脊柱侧凸患者21例,其中男性8例,女性13例;年龄10-19岁,平均14.9岁;所有患者均行后路椎弓根螺钉固定术,术后胸腰支具保护3个月;术前术后行脊柱X线片测量冠状位胸弯与腰弯Cobb角,并测量C7中点垂线与骶骨中垂线(CSVL)的平均距离(C7-CSVL),术前按Lenke法进行分型,Nash-Moe法对椎体旋转程度进行分级。结果:患者术前胸弯Cobb角平均52.4°,术后为12.3°,矫正率为76.5%,末次随访14.6°,矫正率为72.1%,平均丢失2.3°;术前腰弯Cobb角平均43.7°,术后为10.8°,矫正率为75.3%,末次随访12.1%,矫正率72.3%,平均丢失1.3°;C7-CSVL由术前平均6.3 cm矫正为1.8 cm。术后随访24-48个月,平均32个月,未发现假关节形成,无明显畸形丢失。结论:使用后路椎弓根螺钉固定系统治疗青少年特发性脊柱侧凸可获得良好的矫正率,且并发症少,疗效满意。

Objective： To evaluate the clinical outcomes of treatment in adolescent idiopathic scoliosis（AIS） with posterior pedicle screw.Methods： Between March 2006 and April 2009,21 cases of AIS patients（8 male and 13 female,average age at 14.9 years old and ranged from 10 to 19 years old） accepted posterior pedicle screw instrumentation.The thoracolumbar brace were used for protection after operation at least 3 months.All the patients were evaluated by X-ray films before and after operation,and Cobb angle on coronal plane and the vertical distance of C7 plumb line to central scaral vertical line（CSVL） were measured.All the AIS patients were classified by Lenke assay,and the rotation of vertebral body was also detected by Nash-Moe assay.Results： The mean preoperative Cobb angle in all patients was 52.4 ° and 43.7 °,respectively.After surgery,the Cobb angle was 12.3 ° and 10.8 °,respectively.The vertical distance from C7 plumb line to CSVL changed from 6.3 cm to 1.8 cm after surgery.All the patients were followed up,the mean follow-up time were 32 months（ranged from 24 to 48 months）,and there were no pseudoarthroses and lose of correction during the follow-up.Conclusion： Posterior pedicle screw instrumentation has excellent clinical effects with minimal complications in the operational treatment of AIS.