生长棒治疗生长中儿童脊柱侧弯时调控功能的X线研究

发布时间：2018-04-08 09:42

本文选题：脊柱侧弯　切入点：生长棒　出处：《中国矫形外科杂志》2017年15期

【摘要】：[目的]探索能反映治疗生长中儿童侧弯生长捧调控作用的X线检查方法,并验证板-棍系统(plate-rod system for scoliosis,PRSS)的调控能力。[方法]对31例置入PRSS的早发型脊柱侧弯进行至少2年的随访,收集术前、术后即刻、术后每次随访的站立位全脊柱正侧位X线片,测量其Cobb角和能反映顶椎楔形变程度的顶椎楔变角(apical vertebral wedge angle,AVWA),分析不同侧弯类型和不同手术时年龄组术后生长发育期间的顶椎椎体两侧生长速度差异、变化趋势与调控作用的关系。[结果]术前Cobb角平均63.74°±20.99°,术后矫正为25.38°±14.76°,末次随访时为31.68°±19.53°,无明显矫正丢失(P0.05)。术后即刻AVWA平均13.74±5.88°,末次随访时平均8.74°±5.08°,平均减小5.00°±4.46°,差异有统计学意义(P0.05)。AVWA的度数在术后总体呈下降趋势,反映侧弯椎体凹侧的生长速度超过凸侧。先天性脊柱侧弯的AVWA虽然在术后的测量起始阶段大于特发性脊柱侧弯的AVWA,但两者角度在术后的生长期间,总体都呈减小趋势,只是前者波动较明显。5岁前接受PRSS治疗的脊柱侧弯,其初始AVWA较小,且术后AVWA减小过程更平稳。[结论]测量术后生长中儿童侧弯的顶椎楔变角(AVWA),发现楔形变程度变小,是由于PRSS放置后使顶椎体两侧不对称生长发生了逆转,使凹侧生长速度超过凸侧,椎体两侧高度差减小造成的,反映了PRSS对儿童脊柱侧弯椎体两侧生长速度的调控作用。测量比较AVWA的变化是评价生长棒调控效果的一种可靠的检查方法。
[Abstract]:[objective] to explore the method of X-ray examination which can reflect the regulatory effect of lateral bending growth in children and to verify the control ability of plate-rod system for sclerosism.[methods] 31 cases of early onset scoliosis with PRSS were followed up for at least 2 years.The Cobb angle and the apical vertebral wedge AVWAA, which can reflect the degree of wedge degeneration of the apex vertebrae, were measured, and the differences of the growth rates between the two sides of the apex vertebrae during the growth and development of the parietal vertebrae in different types of lateral curvature and at different age groups were analyzed.The relationship between the changing trend and the role of regulation.[results] the mean Cobb angle was 63.74 掳卤20.99 掳before operation, 25.38 掳卤14.76 掳after operation, and 31.68 掳卤19.53 掳at the last follow-up.The mean value of AVWA was 13.74 卤5.88 掳immediately after operation, 8.74 掳卤5.08 掳in the last follow-up, and 5.00 掳卤4.46 掳decrease in average. There was a significant difference in the degree of P0.05U .AVWA after operation, which indicated that the growth rate of the concave side of the lateral curved vertebral body was higher than that of the convex side.Although the AVWA of congenital scoliosis was larger than that of idiopathic scoliosis in the initial stage of postoperative measurement, the angles of both were decreased in general during the growth period after operation.However, the initial AVWA of scoliosis treated with PRSS before 5 years of age was smaller and the AVWA decreased more smoothly after operation.[conclusion] Av WAA was measured in children with lateral curvature after operation. It was found that the degree of wedge-shaped degeneration was reduced because the asymmetric growth of both sides of the acrovertebral body was reversed after placement of PRSS, and the growth rate of concave side was higher than that of convex side.The decrease of height difference of vertebral body reflects the effect of PRSS on the growth rate of children with scoliosis.Measuring and comparing the changes of AVWA is a reliable method to evaluate the effect of growth rod regulation.
【作者单位】：安徽医科大学武警总医院临床学院;武警总医院;
【分类号】：R726.8

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