后路Dynesys矫形内固定术治疗Lenke1、Lenke5型青少年特发性脊柱侧凸的早期疗效

Early efficacy of posterior Dynesys corrective internal fixation surgery for Lenke1 and Lenke5 adolescent idiopathic scoliosis

目的:评估后路Dynesys矫形内固定术治疗Lenke1、Lenke5型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的早期疗效。方法:回顾性分析2019年11月~2023年9月于我科接受Dynesys矫形内固定治疗的15例(男4例,女11例)AIS患者,平均年龄15.5±2.2岁(12~21岁),其中Lenke1型5例、Lenke5型10例,以胸腰段畸形为主。通过复习病历,对手术时间、出血量以及手术并发症进行记录;同时对影像学资料进行测量分析。测量指标包括术前、术后1周内(初次复查)及末次随访时侧凸Cobb角、胸椎后凸、腰椎前凸、腰椎活动度等,评估后路Dynesys矫形内固定对脊柱侧凸的矫正效果。结果:所有患者均顺利完成手术,平均手术时间280.8±45.8min,平均出血量194.0±145.5mL,主弯节段数为4.7±1.1,手术节段数为4.7±1.1,随访3~48个月,冠状面主弯Cobb角术前40.8°±5.5°,术后5.5°±4.5°,末次随访时7.6°±5.5°。冠状面脊柱侧凸术后较术前明显改善(P<0.05),主弯术后总矫正率为86.9%,Lenke1型为89.8%,Lenke5型为85.4%,两者无明显统计学差异。末次随访时胸腰椎固定节段活动度8.2°±3.1°。所有患者均未发生手术相关并发症,随访期间未发现螺钉松动、绳索断裂等内置物并发症。结论:Dynesys矫形内固定术可以有效矫正Lenke1、Lenke5型AIS,手术创伤小,术后恢复快,能保留脊柱部分运动功能,术后早期疗效满意。

Objectives:To evaluate the early efficacy of Dynesys corrective internal fixation system in the treatment of Lenke1 and Lenke5 adolescent idiopathic scoliosis(AIS).Methods:A retrospective analysis was conducted on 15 AIS patients(4 males and 11 females)who underwent Dynesys corrective and internal fixation treatment in our department from November 2019 to September 2023.The average age of the patients was 15.5±2.2 years(12-21 years).Among the patients,there were 5 cases of Lenke1 type and 10 cases of Lenke5 type,mainly characterized by thoracolumbar deformities.The operative time,bleeding volume,and complications were recorded by reviewing medical records,and imaging data were measured and analyzed.The measurement indicators included Cobb angle,thoracic kyphosis,lumbar lordosis,and lumbar range of motion at preoperation,first follow-up within 1 week after surgery,and final follow-up to evaluate the corrective effect of posterior Dynesys corrective internal fixation on scoliosis.Results:All the patients successfully completed the surgery and were followed up for 3-48 months.The average operative time was 280.8±45.8min,average bleeding volume was 194.0±145.5mL,the number of main curvature segments was 4.7±1.1,and the number of operative segments was 4.7±1.1.The Cobb angle of the coronal plane was 40.8°±5.5°before surgery,5.5°±4.5°after surgery,and 7.6°±5.5°at final follow-up.Coronary scoliosis improved significantly after surgery(P<0.05),with a total correction rate of 86.9%for the main curvature,89.8%for Lenke1 type,and 85.4%for Lenke5 type.There was no significant statistical difference between the two types.At final follow-up,the range of motion of the thoracolumbar fixed segment was 8.2°±3.1°.All patients did not experience any operation-related complications,and no implant complications such as loose screws or broken ropes were found during follow-up.Conclusions:Dynesys corrective internal fixation surgery can effectively correct Lenke1 and Lenke5 AIS,with minimal surgical trauma,fast postoperative recovery,preservation of partial spinal motor function,which has satisfactory early postoperative outcomes.