前路Moss Miami器械矫形治疗特发性胸腰段或腰段脊柱侧凸

Anterior correction of idiopathic thoracolumbar or lumbar scoliosis with Moss Miami instrumentation

目的:评价Moss Miami前路矫形系统对特发性胸腰段或腰段脊柱侧凸的手术效果.方法:对21例胸腰段或腰段特发性脊柱侧凸患者经前路胸腹联合入路行Moss Miami矫形内固定,自体肋骨椎间植骨融合术.测量手术前后Cobb角以及躯干侧方位移.结果:Cobb角术前平均53°,术后平均5°,矫正率为90%.上方代偿性胸椎侧凸术前平均17°,术后矫正至平均5°.下方代偿性腰骶椎侧凸术前平均43°,术后自发矫正至19°.随访12～24个月,Cobb角平均丢失19.7°,胸腰段(T11～L1)术前平均前凸0.3°(0～4°),术后平均后凸3°(0～5°).躯干侧方位移从术前平均26mm矫正至术后5mm.1例术后出现一侧下肢交感神经切断症状,2例术后并发气胸.无感染、截瘫及内固定失败等并发症发生.结论:Moss Miami前路器械具有操作简单和低切迹的优点.棒的预弯、去旋转矫形、正确选择螺钉置入部位和椎间植骨可防止固定节段后凸畸形的形成.对Risser征小于4度的患者应密切观察上方代偿性胸椎侧凸进展情况.

Objective:To evaluate the effectiveness of anterior correction for thoracolumbar or lumbar scoliosis with Moss Miami instrumentation.Method:Twenty-one patients with idiopathic thoracolumbar or lumbar scoliosis were studied retrospectively.All the patients underwent anterior correction with Moss Miami instrumentation by transthoracic thoracoabdominal approach and interbody fusion with autologous rib grafting.The pre-and postoperative coronal and sagittal plane Cobb angle of curves and the amount of trunk shift were measured.Result:Preoperatively,the mean Cobb angle on the coronal plane was53°,and5°postoperatively,with an average correction of90%.The upper compensatory thoracic curve was17°preoperatively and5°postoperatively.The lower compensatory lumbosacral curve corrected spontaneously from43°to19°.Follow-up period ranged from12to24months,the correction loss of the thoracolumbar or lumbar scoliosis curve averaged19.7°.The mean lordosis angle was0.3°(0~4°)before surgery but kyphosis postoperatively averaged3°(0~5°).Trunk shift improved from26mm to5mm.The sagittal alignment of thoracolumbar or lumbar was kept.The sympathectomy effect occurred in1patient.Two patients complaining of postoperative pneumothorax which recovered completely.No complications of infection,paralysis,hardware failure occurred.Conclusion:Moss Miami system is easy to use and lower incisura.The kyphotic tendency of the instrumentation area can be avoided by prebending the rod,derotation correction,modest insertion of the vertebral screws and intervertebral bone grafting.The upper compensatory thoracic scoliosis of patients with Risser sign less than4degree should be closely observed for its high risk of progression.