应用Isola内固定系统矫治重度脊柱侧凸

Isola instrumentation for the treatment of severe scoliosis

目的：探讨Isola脊柱内同定系统矫治重度脊柱侧凸的方法并评价其疗效。方法：1998年6月至2003年1月应用Isola脊柱内同定系统治疗重度脊柱侧凸32例，其中特发性脊柱侧凸25例，神经纤维瘤病性脊柱侧凸3例．神经肌肉性脊柱侧凸4例。冠状面主弯Cobb角92．1°±11．4°(75°～116°)。根据不同的侧凸类型、侧凸角度、柔韧性等采用一期前后路联合矫形、分期前后路联合矫形或单纯后路矫形手术．术中运用悬臂技术产生的平移力进行矫形，同时应用椎板下钛缆同定。比较术前、术后冠状面和矢状面的畸形程度，并通过躯干侧移(LT)值分析躯干平衡的重建。结果：随访6～48个月，平均18个月．全组患者术后冠状面矫形效果明显，Cobb角术后与术前相比有显著性差异(P<0．01)，主弯平均Cobb角矫正率为53．8％，末次随访冠状面Cobb角平均丢失313°±3．80°矢状面上81.3％的患者恢复了胸椎生理性后凸(30°～50°)，84.4％的患者恢复了腰前凸(40°～60°)。术后LT值矫正率为67．1％．与冠状面Cobb角的矫正率呈正相关。结论：应用Isola内固定系统矫治重度脊柱侧凸，利用悬臂技术产生的平移力尤其与椎板下钛缆矫形同定相结合．可获得冠状面上较高的矫正率．同时可获得矢状面的矫正并达到躯干平衡。

Objective:To discuss the application of Isola instrumentation in surgical treatment for severe scoliosis and evaluate its efficacy.Method:32cases of severe scoliosis treated in our department from1998to2003were analysed.25were idiopathic and7neurological.Cobb angles ranged from75°to116°.All had undergone Isola instrumentation.According to different types of curve,magnitude and flexibility of the scoliosis,one staged or staged anterior approach combined with posterior correction or only posterior correction were applied.A translation maneuver was utilized in the correction using the cantilever technique,supplemented by sublaminar wiring with multifilament titanium cables.The follow-up was more than a half year,and average18months.This study aimed to elucidate the effects of this technique in the correction of frontal and sagittal plane curves and the trunk balance.The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift(LT).Result:The corrective efficacy of all patient was significant(P<0.01).Average corrective rate of major curve was53.8%.The correction loss of Cobb angles in the frontal plane was3.3°±3.8°at the last visit in the follow-up.On the saggital plane,81.3%patients have restored nomal thoracic kyphosis and84.4%have restored normal lumbar lordosis.The correction of LT value was67.1%.The postoperative correction in LT values correlated with that of the Cobb angle values in the frontal plane.Conclusion:The translation maneuver,especially when used with the sublaminar titanium cable,result in high correction rates in the frontal plane of the treatment for sever scoliosis.Additionally,the technique is also successful in obtaining normal sagittal contours and correcting balance values.