后路选择性胸腰弯或腰弯融合治疗Lenke 5C型青少年特发性脊柱侧凸

Posterior selective thoracolumlar or lumbar fusion in adolescent idiopathic scoliosis with Lenke 5C curves

目的：评价后路选择性胸腰弯或腰弯融合治疗青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）的临床效果。方法：回顾性分析45例行后路选择性胸腰弯（20例）或腰弯（25例）融合的Lenke 5C型AIS病例,男4例,女41例,平均年龄14.9±2.1岁（12-20岁）。所有病例均行后路椎弓根螺钉内固定矫形融合,平均随访36±20个月（24-105个月）。术前、术后及末次随访时均摄站立位全脊柱正侧位X线片,对躯干偏移、融合节段邻近椎间盘开角、远端融合椎的倾斜、冠状面和矢状面Cobb角进行测量分析。测量数据使用SPSS 17.0统计学软件进行分析。结果：术前胸腰弯或腰弯Cobb角平均47.3°±7.2°,术后矫正至6.4°±4.6°,矫正率（84.8±11.6）%,末次随访时为9.1°±5.4°,矫形丢失2.7°±4.6°。胸弯术前25.7°±7.4°,凸侧Bending像Cobb角7.6°±5.8°,柔韧性（72.7±23.0）%,术后矫正至13.2°±6.7°,自动矫正率（48.5±29.4）%,末次随访14.2°±7.6°,矫形丢失1°±6°。躯干偏移：术前21.3±11.5mm,术后19.5±13.3mm,末次随访10.9±8.9mm。术后近端与远端融合椎邻近椎间盘开角较术后明显减小,且在随访过程中无明显加重。远端融合椎倾斜术后及末次随访时均显著改善。末次随访时,交界性后凸1例,躯干失衡3例,胸弯失代偿并行融合延长手术1例。所有病例末次随访时均未见假关节形成。结论：后路选择性胸腰弯或腰弯融合对Lenke 5C型特发性脊柱侧凸可获得满意矫形效果,胸弯可获得良好的自动矫正,有效缩短了融合节段。

Objectives：To evaluate the outcomes of posterior selective thoracolumbar or lumbar（TL/L）fusion in adolescent idiopathic scoliosis（AIS）with Lenke 5C curves.Methods：45 consecutive AIS patients（Lenke 5C）undergoing posterior selective TL/L fusion with pedicle screw construction were reviewed.The average followup was 36±20 months.Standing anteroposterior,convex side bending and lateral radiographs were measured and analyzed.Results：The average preoperative Cobb angle of TL/L curve was 47.3°±7.2° and corrected to6.4°±4.6° postoperatively with the correction rate of（84.8±11.6）%,and correction loss was 2.7°±4.6° at the final follow-up.The thoracic curve decreased from 25.7°±7.4° preoperatively to 13.2°±6.7° postoperatively with a spontaneous correction of（48.5±29.4）%,and the correction loss was 1°±6° at the final follow-up.Trunk shift decreased from 21.3±11.5mm preoperatively to 19.5±13.3mm postoperatively,which improved significantly to 10.9±8.9mm at the final follow-up.The tilt of lower instrumented vertebra（LIV）was significantly improved after surgery and well maintained at the final follow-up.The preoperative coronal upper and lower instrumented vertebral disc angle（UIVA and LIVA）improved after surgery and did not deteriorate during the follow-up.Coronal trunk decompensation was found in 3 cases,proximal junctional kyphosis in 1 case,and thoracic decompensation in 1 case which had received revision surgery to extend the fusion level.Conclusions：Posterior selective thoracolumbar or lumbar fusion with pedicle screw construction can obtain satisfactory correction of thoracolumbar or lumbar curve and show spontaneous correction of thoracic curve,while saves mobile segments in adolescent idiopathic scoliosis.