前后路联合与后路截骨矫形治疗重度僵硬性特发性胸腰段脊柱侧凸的疗效对比

Comparison of two techniques in severe and rigid idiopathic thoracolumbar scoliosis : anterior- posterior instrumentation versus posterior vertebral column osteotomy

[目的]对比前后路联合内固定术与单纯后路截骨矫形内固定术治疗重度僵硬性特发性胸腰段脊柱侧凸的疗效。[方法]病例选择2004～2010年本院骨科治疗的重度特发性胸腰段脊柱侧凸病例32例,男11例,女21例;平均年龄15.9岁。15例行Ⅰ期前路松解或内固定,Ⅱ期后路内固定融合术;17例行一期后路脊柱截骨矫形内固定术。所有病例术前、术后和随访时均拍摄站立位全脊柱X线片,测量冠状面和矢状面Cobb角;通过调阅病例及随访记录相关并发症。[结果]所有病例均得到1年以上随访,平均随访时间26个月。两组患者术前侧凸、后凸度数、脊柱柔韧性及术后随访时间对比差异无统计学意义(P>0.05);术后侧凸、后凸度数及矫形率以及末次随访侧凸、后凸度数及矫形率对比差异无统计学意义(P>0.05)。手术时间、住院天数前后路组大于后路组(P<0.05)。出血量后路组大于前后路组。并发症包括:前路组术后出现肺损伤1例,创伤性胸膜炎及胸腔积液1例,交感神经损伤致下肢不等热4例。后路组硬膜囊撕裂引起脑脊液漏1例,内固定物断裂1例。[结论]前后路联合与后路截骨矫形术对重度特发性胸腰段脊柱侧凸能获得相似的矫形效果。与前后路组相比,后路组手术时间短,创伤小,无交感神经损伤等特殊并发症,但出血量大,手术难度及风险高。但随着手术技术的提高,后路截骨矫形术仍是目前治疗重度特发性胸腰段脊柱侧凸的主要方法。

[ Objective] To evaluate the efficacy of the two techniques in the treatment of severe and rigid idiopathic thora- columbar seoliosis ： anterior - posterior instrumentation versus posterior vertebral column osteotomy. [ Methods ] A total of 32 cases of severe thoraeolumbar idiopathic scofiosis with 11 males and 21 females were involved in this study. The average age was 15.9 years. Fifteen patients underwent a staged anterior release and posterior fusion, 17 patients underwent one - stage posterior vertebral column osteotomy. All radiographic measurements were made on the preoperative, immediate postoperative, and final postoperative radiographs of every patient. Radiographic analysis included Cobb measurements of the coronal and sagittal plane. Curve flexibility was determined on the preoperative supine side - bending anteroposterior radiographs. The medical records were reviewed and the complications were recorded. [ Results ] All patients had been followed up for more than 1 year, the av- erage follow - up time was 46 months. There were no statistically significant differences between the groups for preoperative eoro- nal/sagittal Cobb measurements, coronal curve flexibility, or amount of postoperative and the last follow - up coronal/sagittal Cobb correction. （P 〉 0. 05 ） . However, the anterior and posterior group demonstrated longer operative time and hospital days compared with the posterior groups （P 〈 0. 05 ） . But the posterior group had a more bleeding loss. Complications ： the anterior and posterior group included lung injury in 1 case, traumatic pleurisy and pleural effusion in 1 case and sympathetic injury in 4 cases. The posterior group included eerebrospinal fluid leakage in 1 ease and internal fixation fracture in 1 case. [ Conclusion] The two techniques can get similar effect in the treatment of severe idiopathic thoracolumbar scoliosis. Compared to anterior andposterior group, posterior group has a shorter surgery time, lower probability of neurological complications, but larger amount of bleeding loss. With the improvement of surgical techniques, pos- terior vertebral column osteotomy is still the main method for thetreatment of severe idiopathic thoracolumbar scoliosis.