间隔置钉治疗特发性脊柱侧凸的中远期疗效及健康生存质量评估

发布时间：2018-03-20 00:08

  本文选题：特发性脊柱侧凸　切入点：全椎弓根螺钉　出处：《第二军医大学》2015年硕士论文　论文类型：学位论文

【摘要】：【背景与目的】青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是不明原因引起的、发生于青春发育期前后的脊柱结构性三维畸形[1,2],这种畸形包括脊柱在冠状面上的侧凸、矢状面上胸后凸减少或加大,胸腰段后凸或腰段前凸消失以及轴状面上的旋转畸形[3]。AIS是一种最常见的脊柱侧凸畸形,在全部患者中约占80%,报道的发病率为1-3%[4,5]。目前对于轻度(Cobb40°)青少年脊柱侧凸患者,一般采用支具等保守治疗手段,而对于中度或重度脊柱侧凸,则多选择手术治疗。后路椎弓根钉固定矫形术是应用最广泛的术式,获得了良好的矫形效果。增加椎弓根螺钉置钉数量,可以增加锚定点,提高矫形力,但同时增加了医疗成本。因此,如何应用最少的椎弓根螺钉达到最好的脊柱侧凸矫形效果,达到两者之间的平衡?研究这一问题对于特发性脊柱侧凸患者的手术治疗具有重要的临床意义。同时,特发性脊柱侧凸患者不仅存在身体畸形,而且畸形的存在将严重影响患者的心理健康及生存质量[3]。随着生物-心理-社会这一新的医学模式的出现及健康相关生存质量(health-related quality of life,HRQL)研究的发展,越来越多的研究者认识到对于脊柱侧凸的治疗不能单纯以手术的矫正率为唯一指标,而应以追求矫正率的提高以及患者生存质量的改善的统一为最终目的[3]。然而,对于特发性脊柱侧凸患者采用不同置钉密度矫形手术,对其生存质量是否具有显著影响,目前尚缺乏相关研究。针对以上问题,本课题拟回顾性分析在我院行后路椎弓根螺钉间隔置钉矫形的特发性脊柱侧凸患者的术前、术后即刻及术后5年随访的影像学资料,并与全椎弓根螺钉治疗患者作对比,以评估间隔置钉治疗特发性脊柱侧凸的手术效果;在此基础上,以相同时期采用全椎弓根螺钉置钉行脊柱侧凸矫形手术的患者为对照,分析采用不同矫形手术方案对患者生存质量的影响。研究目的:1.评估对于具有良好柔韧性的特发性脊柱侧凸患者采用椎弓根螺钉间隔置钉三维矫形术后随访五年以上手术疗效。2.探讨间隔置钉与全椎弓根螺钉置钉治疗特发性脊柱侧凸患者对其生存质量评分差异并分析其原因。【材料与方法】1.对51例侧凸角度75°,柔韧度40%的特发性脊柱侧凸患者,应用椎弓根螺钉间隔置钉行脊柱侧凸三维矫形手术,分析其术前、术后即刻及末次随访时主弯Cobb角、顶椎旋转度、冠状面整体平衡、矢状面平衡等影像学参数,以及手术时间、术中失血量、术中/术后并发症等相关围手术期情况。2.特发性脊柱侧凸患者被分成两组(全钉组和间隔置钉组),其中间隔置钉组26例,全钉组20例,平均随访时间5.1年。两组患者在性别、年龄、术前主弯Cobb角、主弯所在节段、手术矫正率、术后随访时间等方面无统计学差异(P0.05),间隔置钉组手术费用,术中出血量明显低于全钉组(P0.05)。采用我单位于国际上率先引用并进行文化调适的“简体中文版脊柱侧凸研究会-22量表”(SRS-22)作为生存质量评估所有患者均填写中文版,比较两组间量表单个维度和项目得分的差异,分析两组患者术前、术后及末次随访时生存治疗评价。【结果】1.主胸弯侧凸Cobb角由术前53.6°±6.6°矫正为15.8°±7.4°,末次随访为17.7°±6.1°;顶椎旋转由术前21.4°±7.1°矫正为9.6°±3.0°,末次随访时为11.0°±3.3°;冠状面C7铅垂线与骶正中线距离术前、术后即刻及末次随访分别为-6.3mm±11.2mm、-3.7mm±8.0mm、-3.9mm±5.5mm;矢状面C7铅垂线与S1椎体后上缘距离术前、术后即刻及末次随访分别为-13.3mm±10.7mm、-2.1 mm±5.2mm、-2.9mm±5.0mm。患者侧凸Cobb角、顶椎旋转、冠状面及矢状面平衡术前、术后比较均有显著性差异(P0.05=,末次随访与术后相比无显著性差异(P0.05)。术后2例患者发生了内固定失败,3例出现附加现象,1例发生伤口表浅感染。术中平均失血量为825ml,手术时间为155min。与常规手术策略相比,本组患者椎弓根螺钉置钉数量减少52%。2.两组患者各自术前与术后即刻、术后五年随访组内评分在5个维度均有显著统计学差异(P0.05)。术后即刻与术后五年随访得分在疼痛维度有显著统计学差异(P0.05)。而两组间比较得分在术后即刻与术后五年满意度维度有显著统计学差异(P0.05)。【结论】1.对于侧凸角度75°,柔韧度40%的特发性脊柱侧凸患者,采用椎弓根螺钉间隔置钉可获得与常规矫形侧连续置钉相似的手术疗效,并可明显缩短手术时间、减少术中失血,降低手术费用。2.经过中远期随访,采用间隔置钉手术患者在健康相关生存质量评分中与术前评分有显著差异,而与全椎弓根螺钉相比,两组患者生存治疗评价无显著差异,而术后满意度明显高于全钉组,肯定了间隔置钉矫形手术的中远期疗效,是手术治疗特发性脊柱侧凸的发展方向。
[Abstract]:[Objective] background with adolescent idiopathic scoliosis (adolescent idiopathic, scoliosis, AIS) is of unknown cause, occurs in the puberty before and after spinal [1,2] 3D structural deformity, this deformity including scoliosis in the coronal plane, sagittal thoracic kyphosis on the decrease or increase of thoracolumbar kyphosis or the lumbar lordosis disappeared and rotational deformity of [3].AIS axis on the plane is one of the most common scoliosis deformity in all patients, about 80% of the total reported incidence rate of 1-3%[4,5]. for mild (Cobb40 degree) of adolescent scoliosis patients, generally use the brace conservative treatment, and for moderate or severe scoliosis is surgical treatment. Posterior pedicle screw fixation surgery is the most widely used and achieved good corrective effects. Increasing the number of pedicle screw placement, can increase the anchor point,. High orthopedic force, but also increases the cost of medical care. Therefore, how to use the pedicle screw to reach at least scoliosis had the best effect, to achieve the balance between the two? This issue has important clinical significance for surgical treatment of patients with idiopathic scoliosis. Meanwhile, idiopathic scoliosis patients not only exist physical deformities, and deformity seriously affect the patient's psychological health and quality of life of [3]. with bio psycho social this new medical model and health related quality of life (health-related quality of life, HRQL) research and development, more and more researchers recognize the scoliosis treatment not only to surgical correction was the only indicator, and should be unified in pursuit of the correction rate increase and improve the quality of life of the patients for the ultimate goal of [3]. however, for idiopathic Patients with scoliosis with different implant density in orthopedic surgery, whether the quality has a significant impact on its survival, there is still lack of study. To solve the above problems, this paper analyzed retrospectively in our hospital underwent posterior pedicle screw placement interval correction of idiopathic scoliosis patients before surgery, immediately after surgery and after surgery 5 year follow-up imaging data, and compared with the pedicle screw fixation for the treatment of patients, to evaluate the effect of operation interval pedicle screw fixation for the treatment of idiopathic scoliosis; on this basis, at the same time using pedicle screw fixation for spinal scoliosis surgery patients as the control, analysis of influence by different orthopedic surgery program on the quality of life of patients. Objective: 1. has a good flexibility assessment for the patients with idiopathic scoliosis with pedicle screw placement interval three-dimensional orthopedic patients were followed up for five years to get started To investigate the curative effect of.2. interval pedicle screws and pedicle screw placement for the treatment of idiopathic scoliosis patients quality of life scores on the difference and analysis of its causes. [materials and methods] 1. to 51 cases of scoliosis angle of 75 degrees, the flexibility of the 40% patients with idiopathic scoliosis, pedicle screw placement for spinal spacer the three-dimensional analysis of the scoliosis orthopedic surgery, preoperative, postoperative and the last follow-up when the main bending angle Cobb, apical vertebral rotation, the overall balance of the coronal, sagittal balance parameter imaging, and the operation time, intraoperative blood loss, intraoperative complications during the perioperative period of.2. idiopathic scoliosis patients were divided into two groups (the entire nail group and interval nailing group), the interval of nailing group in 26 cases, the entire nail group 20 cases, the average follow-up time of 5.1 years. The two groups in gender, age, preoperative main bending angle Cobb, where the main bending section, surgery the postoperative correction rate, with the 璁挎椂闂寸瓑鏂归潰鏃犵粺璁″�﹀樊寮�(P0.05),闂撮殧缃�閽夌粍鎵嬫湳璐圭敚�

本文编号：1636615