后路器械矫正脊柱侧凸的疗效

Effect of surgical treatment of scoliosis through posterior spinal instrument

目的 研究不同后路器械矫正脊柱侧凸的疗效。方法 6 2例患者采用后路器械矫正脊柱侧凸 ,其中采用三维器械矫正 17例 ,术前额状面Cobb角 4 0°～ 10 5°,平均 6 4 8° ;一维或二维器械矫正4 5例 ,术前额状面Cobb角 4 5°～ 110° ,平均 70 1°。 2 8例严重脊椎侧凸患者加用全脊柱截骨。结果 三维器械矫正组术后Cobb角矫正至 5°～ 4 6° ,平均 36 4°,平均矫正率 5 6 2 % ;一维或二维器械矫正组术后Cobb角矫正至 10°～ 6 0° ,平均 35 3°,平均矫正率 5 0 3% ,与三维矫正组相比 ,无显著性差异 (χ2=0 0 36 ,P >0 0 5 )。本组只有 1例出现可逆性神经根擦伤 ,无严重神经系统并发症。随访结果显示三维矫正组术后矫正角度丢失较少 ,而一维或二维矫正组角度丢失较多。结论 三维脊柱矫正器械矫正脊柱侧凸效果良好 ,术后矫正角度丢失较少 ;传统的哈氏棒及L棒技术因其价廉仍有其临床应用价值 ,但需注意角度丢失的问题。严重脊柱侧凸的矫正需行脊柱截骨术 。

Objective To evaluate the effect of surgical treatment on patients with scoliosis through posterior spinal instrument. Methods 62 patients with scoliosis were treated, and 17 (group A) were managed with three dimensional corrective instrument. The average Cobb's angle of group A before operation was 64 8°; 45 patients(group B) were managed with Harrington and/or Leuque instrument. The average Cobb's angle of group B before operation was 70 1°. Additional spine osteotomy was used in 28 cases of severe scoliosis. Results The average corrective rate of group A was 56 2%, and that of group B was 50 3% which showed no significant difference from that of group A(χ 2=0 036, P >0 05). But the follow up showed that the loss of corrective angle of group A was less than that of group B. Conclusion The three dimensional corrective instrument is better in the treatment of patients with scoliosis than the Harrington and/or Leuque instrument. The latter can also correct the deformity of scoliosis and is low priced but should tend to the lose of the corrective angle.