前路及后路手术治疗胸腰段特发性脊柱侧凸临床探究.docVIP

前路及后路手术治疗胸腰段特发性脊柱侧凸临床探究 　 作者：郝定均，贺宝荣，吴起宁，王晓东，方向义，刘团江，宋宗让 【摘要】 [目的]对照性研究前路和后路手术治疗青少年胸腰段特发性脊柱侧凸的手术效果。[方法]按照同一标准，从1998年1月～2006年1月手术治疗的231例青少年特发性脊柱侧凸中选出胸腰段脊柱侧凸61例。A组前路手术28例。B组后路手术33例。[结果]随访2～6年(平均 3.5年)。手术时间A组4.5 h±0.8 h，B组3.1 h±1.0 h(Plt;0.01 )。出血量A组1 400 ml±350 ml，B组1 100 ml±230 ml(Plt;0.05 )。术后引流量A组380 ml±190 ml，B组250 ml±150 ml(Plt;0.05 )。固定节段A组4.5±0.6个椎体，B组7.1±1.2个椎体(Plt;0.01 )。平均矫正率A组75%，B组74%(Pgt;0.05)。剃刀背矫正度A组3.8°±2.4°，B组4.1°±2.6°(Pgt;0.05)。2年后矫正度平均丢失A组4.3°±1.4°，B组5.4°±2.1°(Pgt;0.05)。随访2年无假关节及内固定失败病例。术后交界性后凸角B组发生率高(Plt;0.01 )。[结论]畸形的矫正、剃刀背的改善、矫正度的丢失前路和后路相当。后路手术损伤小、出血少，术后引流量少。后路手术容易产生PJK。 【关键词】 青少年; 胸椎; 腰椎; 特发性脊柱侧凸; 手术治疗 　　Abstract: [Objective]To compare the therapeutic effect of posterior and anterior approaches to correct thoracic waist idiopathic scoliosis. [Methods]Sixty-one from 231 adolescent idiopathic scoliosis patients who were operated from January 1998 to January 2006 were selected according to the same sdandard. There were 28 patients in group A who were operated through anterior approach and 33 patients in group B who were operated through posterior approach.[Results]The follow- up duration was from 2 to 6 years (with an average of 3.5 years). Operation time was 4.5±0.8 hours in group A and 3.1±1.0 hours in group B (Plt;0.01). Blood loss was 1 400±350 ml in group A and 1 200±230 ml in group B (Plt;0.05). Draining volume was 380±190 ml in group A and 250±150 ml in group B (Plt;0.05).The fixed segments were 4.5±0.6 centrums in group A and 7.1±1.2 centrums in group B (Plt;0.01). Average correction rate was 75 percent in group A and 74 percent in group B (Pgt;0.05). Corrected degree lost in 2 years was 4.3 ±1.4 in group A and 5.4±2.1 in group B (Pgt;0.05). Corrected degree of razorback was 3.8 ±2.4 in group A and 4.1±2.6 in group B (Pgt;0.05).There were no pseudoarthrosis and internal fixation failure. The incidence of proximal junction kyphosis was higher in group B (Plt;0.01).[Conclusion]Posterior approach has the advantages of less injury,less blood l