胸腰段青少年特发性脊柱侧凸远端融合椎选择的分析研究

发布时间：2018-05-23 14:34

本文选题：青少年特发性脊柱侧凸 + 脊柱融合术　；参考：《重庆医学》2017年35期

【摘要】：目的探讨胸腰段青少年特发性脊柱侧凸(AIS)远端融合椎(LIV)新的选择标准。方法纳入融合胸腰弯且经过1.5年以上随访的患者52例,患者均符合新的AIS选择标准,即术前站立正位X线片骶正中线(CSVL)在侧凸远端接触到的第1椎体为触及椎(TV),且该TV应符合以下要求:Nash-Moe旋转度小于或等于Ⅱ度;凹侧Bending像上CSVL位于TV两侧椎弓根之间;不存在胸腰段及腰段后凸畸形;CSVL距离TV 3~4mm的患者也列入研究范围。所有患者均由同一组经验丰富的脊柱外科医师实施手术,均采用后路全椎弓根钉内固定矫形融合。术前、术后即刻、终末随访均测站立位脊柱全长正侧X线片、卧位左右Bending像,并测量主弯Cobb角、冠状面躯干偏移(TS)、LIV倾斜度(LIVT)、LIV尾侧椎间盘角度(LIVA),观察TV、稳定椎等位置,记录并进行统计分析。结果所有患者均随访18个月以上,平均(23±3)个月。术前、术后即刻、末次随访主弯Cobb角分别为(49.32±11.37)°、(9.08±6.78)°、(10.65±6.68)°,LIVT分为(21.76±4.68)°、(5.17±4.09)°、(5.16±3.08)°,LIVA分别为(7.19±5.16)°、(3.16±2.78)°、(4.17±3.28)°,术后即刻、末次随访时上述各项指标与术前比较,差异均有统计学意义(P0.05)。术前躯干失代偿患者27例,末次随访时5例患者并发躯干失代偿,未较术前增加。将TV作为LIV与采用稳定椎做LIV相比,前者可以节省(1.42±0.45)个融合节段。结论采用新标准进行胸腰段AIS手术治疗比目前临床上常用的方法节省融合节段。
[Abstract]:Objective to investigate the new selection criteria for distal fusion of thoracic and lumbar adolescent idiopathic scoliosis (AIS). Methods 52 patients with thoracolumbar bending were enrolled and followed up for more than 1.5 years. All the patients met the new criteria of AIS selection. In other words, the first vertebra in the distal part of the scoliosis was the first vertebra which was in contact with the distal part of the scoliosis, and the TV should meet the following requirements: the rotation degree of Nash-Moe should be less than or equal to the second degree, the concave Bending image of CSVL was between the pedicles of both sides of the TV, and the first vertebra was in contact with the distal part of the scoliosis. Patients without thoracolumbar and lumbar kyphosis were also included in the study. All patients were operated on by a group of experienced spinal surgeons. All patients were treated with posterior total pedicle screw fixation and fusion. Before and immediately after operation, the full-length X-ray films of the spine in standing position were measured immediately after operation, and the Bending images were measured in lying position. The Cobb angle of the main curvature, the deviation of the coronal torso, the inclination of livid and the angle of the tail intervertebral disc were measured to observe the position of TVV, stable vertebrae, and so on. Record and analyze statistics. Results all patients were followed up for more than 18 months with an average of 23 卤3 months. Before and immediately after operation, the Cobb angle of the main bend in the last follow-up was 4.17 卤3.08 卤4.17 卤5.16 卤5.16 卤5.16 卤5.16 卤3.08 掳, respectively, and the Cobb angle was 10.65 卤6.68 掳LIVT of 21.76 卤4.68 掳and 7.19 卤5.16 掳卤2.78 掳卤4.28 掳respectively. There were significant differences between the two indexes in the last follow-up period and before operation (P 0.05). There were 27 cases of decompensation of trunk before operation and 5 cases complicated with decompensation of trunk at the last follow-up, which were not increased compared with those before operation. Comparing TV as LIV with stable vertebrae as LIV, the former can save 1.42 卤0.45) fusion segments. Conclusion the new standard for thoracolumbar AIS surgery is more economical than the current clinical method.
【作者单位】：兰州大学第二医院脊柱外科;
【分类号】：R726.8

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