特发性脊柱侧凸不同固定术式疗效分析.docVIP

特发性脊柱侧凸不同固定术式疗效分析 　　作者：云才，肖士鹏 作者单位：北京市石景山医院，北京100043 　　【摘要】 目的分析治疗特发性脊柱侧凸的不同手术方法和效果。方法对1989年～2005年收治的34例特发性脊柱侧凸术前、术后临床资料进行分析，总结所采用不同术式的治疗效果。结果34例分别采用了Harrington术式、联合HarringtonLuque(HL)术式、CotrelDubousset(CD)双棍法及Texas ScottishRite Hospital(TSRH)三维矫正，平均矫正率分别为36.42%、45.18%、55.68%、63.28%，采用HL、CD和TSRH手术方法的矫正度均高于Harrington方法，其中以TSRH、CD三维矫正系统效果最好。结论手术矫正特发性脊柱侧凸效果是明显的，尤以近年运用的三维矫正系统效果更为优良。 　　【关键词】 脊柱侧凸;手术;三维矫正 　　Effect of different instrumentations on idiopathic scoliosis 　　YUN Cai,XIAO Shipen 　　Department of Orthopedic Surgery,Shijingshan Hospital,Beijing100043，China 　　Abstract：ObjectiveTo analyze the effect of different instrumentations on idiopathic scoliosis.MethodsThe data before and after the operations of 34 cases of idiopathic scoliosis during the period from 1989 to 2005 were collected and analyzed,and different operative methods were compared for their advantages and disadvantages.ResultsDifferent instrumentations were applied on these 34 cases,which included Harrington,HarringtonLuque(HL),CotrelDubousset(CD),and TSRH 3dimension correction.The average correcting rates were 36.42%,45.18%,55.68%,63.28% respectively,which proved that HL,CD and TSRH were superior to Harrington in the correction rate and that TSRH and CD 3dimension correction were even more remarkable.ConclusionThe effectiveness of 3dimension correction is superior to those of other instrumentations. 　　Key words:scoliosis;operation;three dimension correction 　　脊柱侧凸是一种三维脊柱畸形，即冠状面上侧凸，矢状面上胸后凸加大或减少，腰前凸消失以及轴状面上的旋转畸形。特发性脊柱侧凸是所有脊柱侧凸中最多见的，原因至今不明， 80%病人为结构性侧弯。我院自1989～2005年采用4种方法对34例特发性脊柱侧凸进行了治疗，现总结报告如下。 　　临床资料 　　1一般资料 　　本组34例，男性12例，女性22例;年龄12~33岁，平均17.51岁。侧弯累及节段：胸段15例、胸腰段12例、腰段7例。侧凸程度：Cobb角45°～60°8例，60°～100°23例，100°以上3例。有2例术前合并不全瘫，术后脊髓神经功能基本恢复正常。 　　2治疗方法 　　2.1术前准备30例术前均用颌枕带悬吊牵引3～4周，4例用头骨盆环牵引4周。术前牵引的目的是为了使脊柱、胸廓、肋骨、肋间等组织变得柔软、有弹性，降低术中、术后神经损伤风险，使手术矫形相对容易并能取得良好的术后效果。术前2～3天，拍悬吊下X线片或头骨盆环牵引下正侧位X线片。结合病人年龄、悬吊情况或牵引情况估算脊柱侧凸的最大矫正度。 　　2.2手术方法1989～1992