中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (22): 4051-4055.doi: 10.3969/j.issn.1673-8225.2011.22.015

• 骨科植入物 orthopedic implant • 上一篇    下一篇

椎弓根螺钉和椎板钩选择性融合治疗胸椎青少年特发性脊柱侧弯的差异

付微平1，张海鹰2，楚  戈3，项泽文3，王福忠4，卢  勇5   

  1. 1新疆生产建设兵团农九师医院骨科，新疆维吾尔自治区塔城市  834700
    2新疆第一济困医院，新疆维吾尔自治区乌鲁木齐市  830000
    3新疆自治区中医医院脊柱一科，新疆维吾尔自治区乌鲁木齐市  830000
    4新疆麦盖提县医院外二科，新疆维吾尔自治区喀什市  844000
    5新疆医科大学附属中医医院，新疆维吾尔自治区乌鲁木齐市  830000
  • 收稿日期:2010-11-25 修回日期:2011-05-10 出版日期:2011-05-28 发布日期:2011-05-28
  • 通讯作者: 卢勇，主任医师，博士生导师，副教授，新疆医科大学附属中医医院，新疆维吾尔自治区乌鲁木齐市 830000 xiaochu138@sina.com
  • 作者简介:付微平，男，1973年生，河南省平顶山县人，新疆石河子大学医学院毕业，主治医师，主要从事脊柱矫形及相关生物力学研究。 xiaochu138@sina.com

Selective posterior thoracic fusions for adolescent idiopathic scoliosis: Hooks versus pedicle screws

Fu Wei-ping1, Zhang Hai-ying2, Chu Ge3, Xiang Ze-wen3, Wang Fu-zhong4, Lu Yong5   

  1. 1Department of Orthopedics, Hospital of the Nongjiushi Division, Xinjiang Production and Construction Corps, Tacheng  834700, Xinjiang Uygur Autonomous Region, China
    2First Jikun Hospital of Xinjiang, Urumqi  830000, Xinjiang Uygur Autonomous Region, China
    3First Department of Spine, Xinjiang Hospital of Traditional Chinese Medicine, Urumqi  830000, Xinjiang Uygur Autonomous Region, China
    4Second Department of Surgery, Makit County Hospital, Kashi  844000, Xinjiang Uygur Autonomous Region, China
    5Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Xinjiang Uygur Autonomous Region, China
  • Received:2010-11-25 Revised:2011-05-10 Online:2011-05-28 Published:2011-05-28
  • Contact: Lu Yong, Chief physician, Doctoral supervisor, Associate professor, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Xinjiang Uygur Autonomous Region, China xiaochu138@sina.com
  • About author:Fu Wei-ping, Attending physician, Department of Orthopedics, Hospital of the Nongjiushi Division, Xinjiang Production and Construction Corps, Tacheng 834700, Xinjiang Uygur Autonomous Region xiaochu138@sina.com

PDF

320

被引次数

6

摘要：

背景：既往的文献多报道用椎板钩或联合椎弓根螺钉治疗特发性脊柱侧弯或讨论融合节段的选择。
目的：比较椎弓根螺钉和椎板钩治疗青少年特发性脊柱侧弯临床疗效的差异，并行影像学评价。
方法：选择66例连续观察的青少年特发性脊柱侧弯(胸段主弯、腰段代偿弯)患者，均行后路内固定融合，末端融合到T12或L1椎体。其中32例行椎板钩内固定，34例行椎弓根螺钉内固定，内固定后最少随访2年。
结果与结论：椎弓根螺钉组患者内固定后胸段Cobb角矫正程度及腰段Cobb角自发矫正程度明显大于椎板钩组(P < 0.001)。椎板钩组内固定后13例患者冠状面朝左侧失代偿大于20 mm(参照C7铅垂线)，而椎弓根内固定组仅4例，差异有显著性意义(P < 0.005)。两组患者均无并发症发生。提示后路选择性融合治疗特发性脊柱侧弯(胸段主弯、腰段代偿弯)，与椎板钩相比，椎弓根螺钉有更好的矫正效果且内固定后冠状面失代偿发生率低。

关键词: 特发性脊柱侧弯, 青少年, 椎弓根螺钉, 椎板钩, 后路选择性融合

Abstract:

BACKGROUND: Previous reports have documented to use hooks or pedicle screws with hooks in treating adolescent idiopathic scoliosis (AIS), or to discuss selective spinal segment for fusion.
OBJECTIVE: To compare the clinical and radiographic results of selective posterior thoracic fusion using hooks versus pedicle screws in AIS patients.
METHODS: Sixty-six consecutive patients with major thoracic-compensatory lumbar C modifier AIS curves underwent selective posterior thoracic fusion to T12 or L1 at a single institution. Hooks were used for instrumentation in 32 patients and pedicle screws were used in 34 patients. Patients were evaluated at a minimal 2-year follow-up.
RESULTS AND CONCLUSION: There was no statistical difference between the preoperative thoracic and lumbar Cobb values for the hook group versus the pedicle screw group. The amount of correction obtained surgically of the thoracic Cobb and the amount of spontaneous lumbar Cobb correction were significantly greater in the pedicle screw group (P < 0.001). The incidence of postoperative coronal decompensation, with a greater than 20 mm shift to the left of the C7 plumb line, was higher in the hook group (13 patients) as compared with the pedicle screw group (4 patients) (P < 0.005). There were no complications or reoperations in either group. Selective thoracic fusion of main thoracic-compensatory lumbar C modifier AIS curves with pedicle screws allowed better thoracic correction and less postoperative coronal decompensation than that with hooks.

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