张国华,张顾议,吴启明 选择性胸段侧凸矫正并增强腰段 - 台湾脊椎中心.doc

選擇性胸段側凸矯正並增強腰段側凸自行矯正能力以治療Lenke 1C或2C型自發性脊柱側凸畸型 張國華，張顧議，吳啟明 台灣脊椎中心，台中國軍總醫院骨科 中國台灣 回應作者：張國華 地址：台中縣太平市中山路二段348號kao-wha@803.org.tw [摘要] 目的 檢視以桿槓力法(Cantilever Bending Technique)所提供之可控制的矯正力(controllable corrective forces)儘量矯治 Lenke 1C 或 2C型自發性脊柱側凸之胸段側凸後，腰段側凸自行矯正(spontaneous correction)之結果。方法 37例Lenke 1C或2C型自發性脊椎側凸之連續病例，在同一單位以桿槓力法儘量矯治胸段側凸。分析手術前，手術後及最終隨訪之X光片，追蹤期為2-6年。結果 胸段側凸平均矯正率為83%，其所對應之最終隨訪腰段側凸矯正率為81%。胸段側凸矯正率/柔軟度之人平均比值為2.4，顯示胸段側凸過度矯正(overcorrection)，腰段側凸之矯正率/柔軟度之平均值為1.2，顯示腰椎自行矯正能力增強，所有腰段側凸頂椎橫移距離(apical vertebral translation)均因自行矯正而減少，冠狀面平衡手術前後無明顯變化。結論 以槓桿力矯正法提供可控制的矯正力矯治Lenke 1C或2C型自發性脊柱側凸，允許儘可能的矯正胸段側凸，並可得到增強腰段側凸自行矯正能力的回應。 [關鍵字] 桿槓力法，可控制的矯正力，自行矯正 [Abstract] Objectives：Current intraoperative instrumentation and fusion techniques for selective fusion involve undercorrection of the thoracic curve, while allowing for spontaneous lumbar curve correction and maintaining overall coronal balance. Since the lumbar curve is nonstructural and compensatory, procedures for selective thoracic fusion should approximate the best possible correction of thoracic curve such that resultant spontaneous lumbar curve correction and compensation is maximized. We evaluate the outcome of maximal selective thoracic correction with controllable corrective forces provided by cantilevel bending technique (CBT) for idiopathic scoliosis (IS) in the presence of widely deviated compensatory lumbar curve. Methods：Thirty-seven consecutive IS patients with main thoracic compensatory minor C modifier lumbar curves underwent maximal selective thoracic correction by CBT at a single institution. Radiographs were analyzed before surgery, immediately after surgery, and at most recent follow-up (2-6 years). Results：A mean 83 % thoracic correction was closely matched by a 81 % lumbar correction at most recent follow-up. The mean thoracic curve correction/flexibility ratio was 2.4. Enhanced capacity for spontaneous correction of lumbar curve was evidenced by the mean correction/flexibility ratio of 1.2. Sponta