VCM去旋转和旋棒技术矫正青少年特发性脊柱侧凸的影像效果比较

Evaluation of corrective effect of adolescent idiopathic scoliosis patients treated by vertebral column manipulator and simple rod derotation

[目的]比较VCM去旋转技术(vertebral column manipulator,VCM)和旋棒技术(rod derotation,RD)治疗青少年特发性脊柱侧凸(AIS)的矫正效果。[方法]回顾性分析2008年9月～2011年7月本中心采用VCM去旋转技术矫正的AIS患者20例,其中男6例,女14例;平均年龄14.5岁(10～18岁);取同期采用旋棒技术矫正的AIS患者20例,其中男3例,女17例;平均年龄14.6岁(10～18岁)。两组病例均具有完整的临床资料和术前术后全脊柱X线片、CT平扫+三维重建资料。研究收集两组患者的7项影像数据,包括主弯顶椎旋转角及其矫正率,主弯Cobb角及其矫正率,T_(5～12)后凸角,主弯顶椎偏移(AVT),C_7铅垂线偏移骶骨中央垂线距离(C_7-CSVL),C_7铅垂线偏移骶骨后上角距离(C_7-SSVL),下融合椎倾斜角(LIV-tilt)及其矫正率,并利用统计学独立样本t检验对两组病例术前术后的影像参数进行比较。[结果]两组患者均获得良好的侧凸矫正及冠状面、矢状面平衡重建,术中术后无严重并发症发生。VCM组的主弯顶椎旋转矫正率明显优于RD组,其值分别为平均(62.3±19.5)%和(24.7±22.5)%(P<0.05)。冠状面上,VCM组和RD组的主弯矫正率无明显统计学差异(P>0.05),其均值分别为(79.6±10.4)%和(81.0±10.4)%;虽然两组的LIV-tilt角矫正率无明显统计学差异,但VCM组的矫正率明显高于RD组(VCM组:RD组=75.6%VS 61.6%)。矢状面上,两组患者的术后胸椎后凸和矢状面平衡皆得到良好维持。[结论]VCM去旋转技术矫正青少年特发性脊柱侧凸顶椎旋转的效果优于旋棒技术,并具有潜在矫正下融合椎倾斜角及维持良好胸椎后凸的作用。

[ Objective] To evaluate the radiographic outcomes of AIS patients treated by vertebral column manipulator （VCM） and simple rod derotation （SRD） maneuver. [ Methods ] A retrospective study was designed to compare 2 cohorts in- cluding 40 AIS patients treated by VCM and SRD technique from Sep 2008 to July 2011. In VCM group, there were 20 AIS pa- tients, who were male 6 and female 14, mean age 14.5 years （ range, 10 - 18 years） . In SRD group, 20 AIS patients who were male 3 and female 17, mean age 14. 6 years （range, 10 - 18 years） were also included. All patients had complete record and whole spine PA and lateral X - ray film before and after operation. Seven radiographic variables of pre - operation and post - op- eration were collected and compared between two groups, including apical rotational angle of main curve, Cobb angle of main curve, T5_ 12 kyphosis, coronal C7 to center sacral vertical line （ C7 - CSVL）, the sagittal C7 to center sacral vertical line （ C7 - SSVL）, apical vertebral transition （ AVT）, lowest instrumented vertebra tilt （ LIV - Tilt） angle. [ Results] Scoliosis was suc- cessfully corrected in both groups. All patients were got good coronal, sagittal balance and no severe complications happened dur- ing or after operation. There were no significant differences of seven radiographic parameters between two groups at preoperative and postoperative, except the postoperative corrective rate of apical rotational angle in main curve, which were （62. 3 ± 19.5） % and （24.7 ± 22. 5 ） % in VCM group and RD group, respectively. The average corrective rate of the major curve （MT） in VCM group and SRD group were 79. 6% and 81.0% respectively. The average corrective rates of LIV - tilt angle were 75.6% and61.6%. Moreover, the thoracic sagittal profile was maintained between both groups. [ Conclusion ] VCM technique can improve radiographic axial rotational angle of apical vertebra in main curve than RD technique in AIS patients. It also potentiallyimprove corrective rate of LIV - tilt angle than RD technique and maintains normal thoracic saggital profile.