凹侧双棒撑开治疗重度早发性脊柱侧凸的中期疗效

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摘要目的评估后路凹侧双棒撑开技术治疗重度早发性脊柱侧凸患儿的中期疗效，并分析相关并发症。方法回顾性研究2007年6月至2013年12月于我中心接受凹侧双棒撑开技术治疗的52例重度早发性脊柱侧凸患儿，锚定点均采用椎弓根螺钉固定。通过复习病例资料，对年龄、撑开次数、撑开间隔时间以及并发症进行记录；同时对影像学资料进行测量分析，测量指标包括侧凸Cobb角、胸椎后凸Cobb角和T₁～S₁长度，对畸形的矫正情况进行评估。结果根据患儿平均撑开间隔时间，将病例分为两组：A组有32例，男9例，女23例，初次手术年龄平均(7.4±1.1)岁(4～10岁)，患儿共接受148次手术，手术间隔时间平均12.6个月(4～18个月)，随访时间平均60.7个月(30～102个月)，冠状面主弯Cobb角术前(109±23)°，术后(55±16)°，末次随访时(46±12)°；T₁～S₁长度平均年增长率为1.9 cm/年。B组有20例，男6例，女14例，初次手术年龄平均(7.7±1.3)岁(5～10岁)，患儿共接受54次手术，手术间隔时间平均26.4个月(12～72个月)，随访时间平均61.5个月(29～108个月)，冠状面主弯Cobb角术前(104±19)°，术后(51±13)°，末次随访时(62±17)°；T₁～S₁长度平均年增长率为1.19 cm/年。末次随访时，A组在侧凸、胸椎后凸、躯干偏移矫正方面优于B组，差异有统计学意义(P＜0.05)，但T₁～S₁长度，差异无统计学意义(P＞0.05)。A组有7例患者(21.9％)共发生9例次并发症，B组有12例患者(60％)共发生15例次并发症。结论对于重度早发性脊柱侧凸，采用凹侧双棒撑开技术是一种有效的选择。缩短撑开间隔时间，可减少并发症的发生，并可获得更好的脊柱畸形的矫正与控制。

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关键词 ：早发性脊柱侧凸, 非融合技术, 并发症

Abstract：Objective To analyze the clinical results and perioperative complications of the dual rod distraction technique in the concave side for severe early onset scoliosis(EOS)by mid-term follow-up.Methods 52 patients undergoing dual rod distraction technique in the concave side for severe EOS in our hospital from June 2007 to December 2013 were retrospectively studied.The pedicle screws provided anchors at the end of the rods.The patients’records were reviewed.The parameters included age at initial surgery and the final follow-up，number and frequency of lengthening and complications.Radiographic evaluation included scoliosis Cobb angle，thoracic kyphosis and length of T₁～S₁.Results According to the average frequency of lengthening，the patients were divided into two groups.There were 32 patients(9 males and 23 females) in Group 1.The average age was (7.4±1.1)years(range，4～10 years) at initial surgery.There was a total of 148 surgeries.The average interval between lengthenings was 12.6(range，4～18)months.The mean follow-up was 60.7 (range，30～102)months.Cobb angle decreased from a mean value of (109±23)°preoperatively to (55±16)°after the primary implantation，at final follow-up，the mean Cobb angle was (46±12)°.The average increase of T₁～S₁ length was 1.9 cm per year.There were 20 patients(6 males and 14 females) in Group 2.The average age was (7.7±1.3)years (range，5～10 years) at initial surgery.There was a total of 54surgeries，The average interval between lengthenings was 26.4(range，12～72) months.The mean follow-up was 61.5(range，29～108)months.Cobb angle decreased from a mean value of (104±19)°preoperatively to (51±13)°after the primary implantation，at final follow-up，the mean Cobb angle was (62±17)°.The average T₁～S₁ length was 1.19 cm per year.At final follow-up，the correction of Cobb angle，thoracic kyphosis and trunk shift was better in Group 1 than in Group 2(P＜0.05).As to the T₁～S₁length，there was no significant difference between the two Groups at final follow-up (P＞0.05).There were 9 complications occurred in 7 patients(21.9％)in Group 1 and 15 complications occurred in 12 patients(60％)in Group 2.Conclusion For patients with severe EOS，dual rod distraction technique in the concave side was an effective treatment option.Shortening the interval of lengthening，it can decrease the complications rate and gain better deformity correction while allowing spinal growth.

Key words： early onset scoliosis non-fusion technique complication

通讯作者: 马华松

作者简介: 陈志明(1974－ )，男，副主任医师，解放军306医院骨科，全军脊柱外科中心，100101。

引用本文:

陈志明，马华松 *，吴继功，谭荣，王晓平，赵福江. 凹侧双棒撑开治疗重度早发性脊柱侧凸的中期疗效[J]. 实用骨科杂志, 2017, 23(10): 865-869.
Chen Zhiming，Ma Huasong，Wu Jigong，et al. Dual Rod Distraction Technique in the Concave Side for Severe Early Onset Scoliosis：the Results of Mid-term Follow-up. sygkzz, 2017, 23(10): 865-869.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I10/865

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