僵硬性脊柱侧凸前、后路松解效果的比较

Comparison study of anterior and posterior release in the treatment of rigid scoliosis

目的:比较前、后路松解在僵硬性脊柱侧凸分期治疗中的效果,分析前、后路松解的手术适应证。方法:79例僵硬性脊柱侧凸患者(均为先天性或特发性脊柱侧凸患者),分别一期行脊柱前路或后路松解,头颅骨盆环牵引2～5周,平均18d,二期行矫形内固定术。前路松解组40例,其中先天性脊柱侧凸18例,特发性脊柱侧凸22例。后路松解组39例,其中先天性脊柱侧凸19例,特发性脊柱侧凸20例。对两组患者松解术前、术后Cobb角及脊柱畸形改善率、手术时间和手术并发症进行分析比较。结果:前路松解组先天性脊柱侧凸患者的Cobb角由101°矫正至61°,特发性脊柱侧凸由96°矫正至53°;后路组先天性脊柱侧凸由106°矫正至78°,特发性脊柱侧凸由89°矫正至63°,脊柱畸形改善率前路松解优于后路松解(P<0.05)。两组的手术时间、手术并发症均无显著性差异。结论:前路松解的脊柱畸形改善率明显优于后路松解,前路松解更适合于僵硬性脊柱侧凸的一期松解,不适合行前路松解的患者可选择后路松解。

Objective:To compare the clinical effect of anterior and posterior release in treatment of rigid scoliosis,evaluate the indication of anterior and posterior release.Method:79patients of rigid scoliosis,treated with anterior or posterior release in first-stage,and after2to5weeks distraction(average18days)corrected with instrument in second-stage since March1994to November2003were reviewed.The Cobb angle,correction rate,operation time and complications were compared between anterior release group(including18cases congenital scoliosis and22cases idiopathic scoliosis)and posterior release group(including19cases congenital scoliosis and20cases idiopathic scoliosis).Result:In anterior group,the Cobb angle of congenital scoliosis were developed from101°to61°,and the idiopathic scoliosis were developed from96°to53°;in posterior group,the Cobb angle of congenital scoliosis were developed from106°to78°,and the idiopathic scoliosis were developed from89°to63°.The correction rate of anterior group was superior to posterior group(P<0.05),there was no obvious different in operation time and complications between two groups.Conclusion:The correction rate of anterior release is superior to posterior release.Anterior release is more suitable for rigid scoliosis in first-stage operation;the posterior release is necessary in some conditions.