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生长棒治疗后凸型早发性脊柱侧凸的效果及并发症
  • ISSN号:0253-2352
  • 期刊名称:《中华骨科杂志》
  • 时间:0
  • 分类:R657.4[医药卫生—临床医学;医药卫生—外科学]
  • 作者机构:南京大学医学院附属鼓楼医院脊柱外科,210008
  • 相关基金:国家自然科学基金青年基金(81401848);江苏省临床医学中心(2016)
中文摘要:

目的探讨后凸型早发性脊柱侧凸(early—onsetscoliosis,EOS)在生长棒治疗期间的脊柱矢状面参数改变以及并发症情况。方法收集2009年11月至2016年11月在我科接受生长棒技术治疗的32例EOS患者,所有患者均经2次以上撑开手术以及2年以上随访,其中男8例,女24例。根据正常儿童R。胸椎后凸角(thoracic kyphosis,TK)参考值分为正常后凸组(TK为20°-50°,15例,男4例,女11例)和过度后凸组(TK〉50°,17例,男4例,女13例),两组的病因学构成比相似,术前平均年龄分别为(6.2±2.0)岁和(6.3±2.3)岁,脊柱侧凸柔韧度分别为34.6%±10.4%和35.8%±11.2%。术中将预弯好的钛棒穿过深筋膜下方肌肉,分别与近端、远端锚定点、连接阀或多米诺连接器相连,适当撑开后两端锁紧,并将生长阀或多米诺连接器植于胸腰段深筋膜下。结果正常后凸组和过度后凸组随访时间分别为(5.5±1.9)年和(5.5±2.1)年。正常后凸组和过度后凸组的近端及远端固定椎体分布相似,平均撑开次数分别为(5.1±2.0)次和(5.3±2.3)次,撑开间隔时间分别为(11.3±2.3)个月和(10.9±1.9)个月。正常后凸组的TK由术前36.0°±9.4°减至术后的30.6°±8.3°,末次随访时为32.2°±7.8°,均维持在正常范围内;过度后凸组的TK由67.6°±11.6°减至41.7°±8.7°,差异有统计学意义,矫正率为38.3%±14.6%,末次随访时轻度增至46.5°±8.4°,与术后相比差异无统计学意义,矫正丢失率为7.1%±4.2%。并发症发生率:过度后凸组(33.3%)高于正常后凸组(76.5%),差异有统计学意义。最常见的内固定相关和矢状面形态相关并发症分别是断棒(15.6%)和近端交界性后凸(proximal junetional kyphosis,PJK,21.9%),正常后凸组和过度后凸组的断棒率分别

英文摘要:

Objective To evaluate the changes in sagittal profiles and complications during treatment with growing rods (GRs) in hyperkyphotic early-onset scoliosis (EOS). Methods From December 2009 to December 2016, a total, of 32 EOS patients who received growing rods treatment in our center, including 8 males and 24 females, were reviewed retrospectively. All the patients had minimum 2-year follow-up and over 2 lengthenings. Based on the reference value of thoracic kyphosis (TK) in T2-12 of normal children, the patients were categorized into an N group (20°≤TK≤50°, 15 cases, 4 males and 11 females) or K group (TK≥50°, 17 cases, 4 males and 13 females). The distribution of etiology was similar between the two groups. The average age was (6.2± 2.0) years and (6.3±2.3) years respectively, curve flexibility was 34.6%± 10.4% and 35.8%± 11.2% before surgery. The precon- toured rods were tunneled submuscularly, connecting proximal and distal anchors, and tandem or domino connectors. The rods were then locked after applying direct distraction that allowed appropriate elongation. The connectors were all placed under the deep fascia. Results The mean follow-up in the N and K groups was (5.5±1.9) years and (5.5±2.1) years, respectively. The distribution of proximal and distal anchors was similar between the two groups. The N and K groups, respectively, had an average number of lengthenings of 5.1±2.0 and 5.3±2.3, with mean lengthening intervals of (11.3±2.3) months and (10.9±1.9) months, respectively. In the N group, TK was decreased from 36.0°±9.4° to 30.6°±8.3° after surgery, and to 32.2°±7.8° at the last follow-up, dem- onstrating it was maintained within the normal range. In the K group, TK was markedly reduced from 67.6°±11.6° to 41.7°±8.7° after the index surgery, with a correction rate of 38.3%±-14.6%, and the difference was statistically significant. And then it slightly increased to 46.50±8.4- at the last follow-up, with correction loss of 7.1%?

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期刊信息
  • 《中华骨科杂志》
  • 中国科技核心期刊
  • 主管单位:中国科学技术协会
  • 主办单位:中华医学会
  • 主编:
  • 地址:天津市河西区解放南路406号
  • 邮编:300211
  • 邮箱:gktougao@126.com
  • 电话:022-28334734 28278929
  • 国际标准刊号:ISSN:0253-2352
  • 国内统一刊号:ISSN:12-1113/R
  • 邮发代号:6-17
  • 获奖情况:
  • 中国期刊方阵“双效”期刊
  • 国内外数据库收录:
  • 俄罗斯文摘杂志,美国化学文摘(网络版),英国农业与生物科学研究中心文摘,波兰哥白尼索引,美国剑桥科学文摘,日本日本科学技术振兴机构数据库,中国中国科技核心期刊,中国北大核心期刊(2004版),中国北大核心期刊(2008版),中国北大核心期刊(2011版),中国北大核心期刊(2014版),中国北大核心期刊(2000版)
  • 被引量:67445