后路矫形侧间隔置钉、支撑侧每隔3～4个节段置钉治疗92例Lenke1型青少年特发性脊柱侧凸临床分析

Clinical analysis of 92 cases of Lenke type 1 adolescent idiopathic scoliosis treated by posterior skipped pedicle screw fixation in correction side and 3 or 4 segment interval fixation in support side

[背景]观察后路矫形侧间隔置钉、支撑侧每隔3~4个节段置钉治疗Lenke1型青少年特发性脊柱侧凸(AIS)的临床疗效.[病例报告]回顾性分析2001年6月—2010年12月间接受后路双侧椎弓根钉置钉治疗的92例Lenke1型AIS患者的影像学资料,测量术前、术后及末次随访时胸椎及腰椎Cobb角、冠状位平衡(骶骨中垂线与C7铅垂线的距离,C7-CSVL)、双肩高度差、胸椎后凸(TK)及腰椎前凸(LL)值,计算术前胸椎和腰椎侧凸的柔韧性、术后Cobb角的矫正率及双侧平均置钉密度.患者平均年龄13.2岁,随访时间平均为5.6年,平均固定节段为9个,平均置钉数为矫形侧5.1个,支撑侧3.1个.术后和末次随访时胸弯及腰弯Cobb角均较术前明显减小(P<0.05),术后和末次随访时比较差异无统计学意义(P>0.05);术前、术后及末次随访时的TK和LL间差异均无统计学意义(P>0.05);术前与术后1周内C7-CSVL间差异无统计学意义(P>0.05),但末次随访时的C7-CSVL较术前和术后1周内明显变小(P<0.05);术后及末次随访时双肩高度差均较术前明显减小(P<0.05),术后和末次随访时比较差异无统计学意义(P>0.05).[讨论]后路矫形侧间隔置钉、支撑侧每隔3~4个节段置钉治疗Lenke1型AIS疗效满意,可减少置钉数量,缩短手术时间,减轻患者经济负担.

BACKGROUND To observe the clinical effects of posterior skipped pedicle screw fixation in correction side and 3 or 4 segment interval fixation in support side on Lenke type 1 adolescent idiopathic scoliosis（AIS）.CASE REPORTSThe imaging data of 92 Lenke type 1 AIS patients who received posterior bilateral pedicle screw fixation treatment between June 2001 to December 2010 were analyzed retrospectively.The preoperative,immediate postoperative and final follow-up Cobb angle,coronal balance（the distance between sacrum midperpendicular and C7 plumb line,C7-CSVL）,shoulder height difference,the value of thoracic kyphosis and lumbar lordosis were measured.The preoperative flexibility of anterior thoracic and lumbar protruding,postoperative correction rate of Cobb angle and bilateral average density of pedicle screw were calculated.The mean age of the patients was 13.2 and the average follow-up time was 5.6 years.The average fixed segment was 9,and the average density of pedicle screw was 5.1 in correction side and 3.1 in support side.Both the thoracic and lumbar Cobb angles were significantly reduced during post-operation and final follow-up as compared with pre-operation（P0.05）, there was no statistically significant difference in Cobb angles between post-operation and final follow-up（P0.05）.There was no significant difference in thoracic kyphosis and lumbar lordosis before and after surgery and final follow-up（P0.05）.No difference was found in C7-CSVL before and1 week after surgery（P0.05）,but C7-CSVL decreased significantly in final follow-up as compared with pre-operation and 1 week post-operation（P0.05）.Shoulder height difference of post-operation and final follow-up was decreased significantly as compared with pre-operation（P0.05）,there was no statistically significant difference between post-operation and final follow-up（P0.05）.DISCUSSIONPosterior skipped pedicle screw fixation in correction side and 3 or 4 segment interval fixation in support side showed satisfactory effects in Lenke type 1 AIS patients.This technique could reduce operating time,screw density,and also decrease the economic burden on patients.