关于后路三棒固定(凹侧双棒)治疗重度僵硬性脊柱侧凸的研究

Safety and effect of posterior triple-rod construct with double-rod in concave side in correction of severe and rigid scoliosis

背景:重度僵硬性脊柱侧凸的治疗具有挑战性,目前众多的治疗方法,如牵引、前路松解、截骨等,也是疗效与问题并存,需要探索新的治疗方式。目的:探讨后路三棒固定(凹侧双棒)治疗重度僵硬性脊柱侧凸的安全性和疗效。方法:回顾性分析2014年1月至2015年10月于我院接受后路Ⅰ期矫形手术的8例重度僵硬性脊柱侧凸患者的临床资料。分别测量手术前后及末次随访时主弯Cobb角、柔韧性、顶椎偏距、躯干偏移、胸椎后凸、腰椎前凸等影像学指标。手术均在主弯凹侧采用长短双棒进行撑开矫形,在凸侧放置第3根棒加压矫形。结果:主弯Cobb角术前100°~131°,平均118.5°±12.0°,柔韧性0%~18.2%,平均11.6%±5.6%;术后40°~94°,平均60.1°±16.8°,较术前明显改善(t=9.3,P<0.001),矫正率26.5%~66.6%,平均49.1%±13.2%;末次随访46°~91°,平均62.6°±14.7°,较术前明显改善(t=13.2,P<0.001)。手术时间230~385 min,平均(302.5±45.5)min;出血量600~1300 ml,平均(962.5±272.2)ml;置入物密度43.3%~69.2%,平均55.5%±8.2%。术中脊髓监测无异常,术后无神经损伤、内固定失败等并发症发生。结论:后路三棒固定(凹侧双棒)治疗重度僵硬性脊柱侧凸能获得良好的矫形效果,安全可靠。

Background： The treatment of severe and rigid scoliosis is challengeable. Efficacy and problems coexists in all therapies, such as Halo traction, anterior release and osteotomy. So it is necessary to explore new treatment methods. Objective：To explore the safety and efficacy of triple-rod construct with double-rod in concave side in correction of severe and rigid scoliosis. Methods： A total of 8 patients with severe and rigid scoliosis who underwent one-stage posterior corrective operation of triple-rod construct（double-rod in concave side） from January 2014 to October 2015 were recruited into this retrospective study. Major curve Cobb angle, flexibility, apex vertebra translation（AVT）, trunk shift（TS）, thoracic kyphosis（TK） and lumbar lordosis（LL） were measured through standing posterior-anterior（PA） X-ray pre-operatively, post-operatively and at the final follow-up. During operation, double rods（one short and one long） were implanted into the concave side and distended. The third rod was implanted in the convex side and compressed. Results： The mean pre-operative Cobb angle of major curve was 118.5°±12.0°（range, 100°-131°） and flexibility was 11.6%±5.6%（range, 0%-18.2%）. The mean post-operative Cobb angle was 60.1°±16.8°（range, 40°-94°）, which was significantly improved compared to pre-operative one（t=9.3, P〈0.001）; the mean corrective rate was 49.1%±13.2%（range, 26.5%-66.6%）. The mean Cobb angle at final follow-up was 62.6° ± 14.7°（range, 46°-91°）, which was significantly improved compared to pre-operative one（t=13.2, P〈0.001）. The mean operation duration was（302.5±45.5） min（range, 230-385 min）. The mean blood loss was（962.5±272.2）ml（range, 600-1300 ml）. The mean implant density was 55.5%±8.2%（range, 43.3%-69.2%）. No abnormal signal from the monitor on spinal cord was detected during operation. No complications such as neurologic injury or implant failure were found. Conclusions： The posterior operation with triple-rod construct（double-rod in concave side） has satisfactory correction and low prevalence of complication in correction of severe and rigid scoliosis.