改良通用脊柱内固定系统治疗生长发育期脊柱畸形209例报告_医学论文.docVIP

改良通用脊柱内固定系统治疗生长发育期脊柱畸形209例报告_医学论文 改良通用脊柱内固定系统治疗生长发育期脊柱畸形209例报告_医学论文 作者：高吉昌　陈庆贺　屈金良　王正雷　张承敏　王仑　晁民【摘要】 　　［目的］研制改装通用脊柱内固定系统（USS）为两端滑动中段锁定横连杆套式滑动的椎弓根螺钉固定框架结构，经后路手术治疗生长发育期脊柱畸形。［方法］自2000年6月～2006年6月使用改装USS系统内固定治疗生长发育期脊柱畸形209例。男106例，女103例，其中特发性脊柱侧弯92例，先天性脊柱侧弯72例，青年驼背26例，其他19例。年龄：女8～14岁，男10～16岁，平均13.22岁。改装USS系统后路顶椎为中心3～5椎节置锁定螺钉，其余两端椎节均为滑动螺钉。双横连杆与矫形棒连接处为锁定结构、协同固定矫形棒、而横连杆连接处为套管式滑动。这种改装的USS系统不影响脊柱的纵向生长和两椎弓根的横向间发育。［结果］本组209例，术后26～60个月随访96例。畸形度数Cobb角45°～110°，平均Cobb角68°，术中矫形脊柱增高4～15 cm，平均7 cm，平均增高2.4 cm。断棒3例，但无移位及神经症状。［结论］改装USS系统的两端滑动中段锁定椎弓根螺钉框架后路手术固定矫形保留中段锁定不失原有的三维矫形力度、矫形力量强度、钢度。两端滑动不限制脊柱继续生长，滑动的横连杆不限制椎弓根间横向发育，术后26～60个月随访观察疗效满意。 【关键词】 脊柱畸形 脊柱固定器械 锁定与滑动 脊柱生长 　　Study and clinical application of improved USS system to correct spinal deformity of growth period—a report of 209 cases∥ 　　Abstract：［Objective］To study the effect of improved universal pedicle screw systems which combined locking pedicle screws with sliding pedicle screws to correct the spinal deformities in growth period through posterior incision.［Method］From June 2000 to June 2006,209 spinal deformities in growth period were treated（106 males and 103 females）,including 92 idiopathic scoliosis,72 congenital scoliosis,26 Scheuermann（average 13.22 years）.Locking pedicle screws were placed into pedicles of apical vertebra and the 3 to 5 adjacent vertebrae.Sliding pedicle screws were putted into pedicles of cephalic and caudal vertebrae.Double crosscrosslinks themselves could cannula prolonged to fit for the transverse development of vertebrae.［Result］Totally 209 cases with preoperative Cobb（average 68 degree）were instrumented with improved USS systems and 96 cases were followed up for 26～60 month.The length of spines were prolonged 4 cm to 15 cm with average 7 cm.With 26 months to 60 months followcmplication was detected.［Conclusion］Improved USS system which combined locking pedicle screws with sliding pedicle screws had the three dimensional power and intensity of traditional 3D instrumentations.Sliding pedicle screws an