【作者】 王昊明；

【导师】 王辉；

【作者基本信息】 延边大学 ， 骨外科， 2010， 硕士

【摘要】 研究背景脊柱侧凸是指脊柱的一个或数个节段向侧方弯曲伴有椎体旋转的三维脊柱畸形。国际脊柱侧凸研究学会(Scoliosis Research Society, SRS)对脊柱侧凸定义：应用Cobb法测量站立正位X线的脊柱侧向偏离曲度达到10°以上的畸形,常见于青少年儿童,严重影响患者的身心健康。脊柱侧弯多在青春期发病,低龄甚至新生儿患脊柱侧弯的比例正在不断攀升,而他们较青少年和成人有更大风险：发展到七八岁时即会严重阻碍呼吸、影响心肺功能发育,从而引发死亡。低龄儿童脊柱侧弯必须尽早手术,否则可能失去手术机会。其中青少年特发性脊柱侧凸最为常见,目前发病机制尚不明确。随着脊柱椎弓根螺钉内固定系统的不断改进,以及三维矫形技术理论的广泛应用,脊柱侧凸畸形得到了有效的治疗。其中,部分患者术后出现了失代偿现象,这使人们意识到需要一种全面有效的分型系统用以指导手术。King分型及其他分型系统的相继出现,有效地指导了脊柱侧凸矫形手术治疗。各种分型有其各自的应用特点,亦有相互联系之处。如何应用分型区分畸形的特点,如何选择正确的融合节段,是脊柱侧凸矫形手术的关键。研究目的1.系统回顾脊柱侧凸后路矫形内固定手术治疗特发性脊柱侧凸的临床效果。2.探讨King分型系统在脊柱侧凸后路椎弓根内固定矫形术的应用价值并且比较此种分型在矫形术中所起到的指导意义。3.正确的选择性的融合胸椎矫正侧凸患者的临床效果,研究分析跨阶段融合椎体对术后躯干的影响。4.深入地了解及应用国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)进行患者健康相关的生活质量评价及分析。研究方法1.采集自2005年9月份-2009年12月份曾经在我院行脊柱侧凸后路椎弓根镙钉内固定矫治青少年特发性脊柱畸形患者30例,男性11例,女性19例,年龄11岁-23岁,平均年龄14.2岁。病史1-5年,30例均属特发性脊柱侧凸。按照King分型分为,King I型7例,Ⅱ型10例,Ⅲ型8例,Ⅳ型3例,Ⅴ型2例。术前脊柱冠状面畸形Cobb角为45°-72°,平均58.1°,。术后随访6-28个月,平均16.4个月。根据侧弯患者术前及术后随访时X线光片,对站立位冠状面的Cobb角进行测量,讨论整体治疗效果。2.根据所有患者病例应用King分型系统进行分型,脊柱侧凸患者采用后路椎弓根螺钉内固定系统进行矫形融合手术。根据King分型的指导原则对患者进行手术矫形,根据手术后结果及随访结果将30份病例进行分析,评价各组术后失代偿的情况,分析King分型对手术的指导意义。3.根据国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)对本次研究中的23位患者进行术前及术后生活质量评分。研究结果1.术后所有病例经随访6-28个月,平均16.4个月。术前冠状面Cobb角平均58.1°,术后平均21.3°,平均矫正率为63.0%；顶椎移位距离术前平均2.7cm,术后平均1.1cm,平均矫形率为59.0%;旋转畸形(Nash-Moe法)术前为I-III度,术后平均矫形I度。身高比术前平均增加7cm。所有患者术中、术后均无脊髓神经损伤,未发生任何松钉、断棒现象,植骨愈合率高,达到了脊柱的整体平衡。术后1年均获得满意的脊柱愈合,并保留一定的脊柱活动度,无曲轴现象及附加现象,无其它并发症。随访矫正度丢失4.5°2.整体治疗情况：术前共计30例存在冠状面躯干失平衡,术后终末随访时仍有7例(25%)。3.采用国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)术前及术后生活质量评分,发现通过进行后路矫形手术的患者从心理性、功能性及生活质量有较大的改善。4.主胸弯矫正结果：30例患者术前胸弯Cobb角平均58.1°,术后21.3°,矫正率63.0%；术前代偿腰弯Cobb角平均36.1°,术后17.5°,矫正率53.6%。研究结论1.脊柱后路椎弓根镙钉内固定系统进行脊柱侧凸的矫形,可以取得良好的治疗效果。2.特发性脊柱侧凸King分型系统能有效地指导矫形手术治疗；正确分型的基础上,选择正确椎体的融合范围进行适度的矫正,对手术成功起到比较重要的作用。3.了解及应用了国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)可以帮助我们比较了解患者自身对术前与术后生活质量的自我评价。4.有效的植骨融合对术后尽快回复取得了良好的效果,并防止假关节发生,同时给予坚强的内固定。以增加其成骨能力,促进植骨愈合。更多还原

【Abstract】 BackgroundScoliosis refers to the spine of one or several section to lateral bending with vertebral rotating 3d spinal deformity. International Scoliosis Research institute (SRS), Scoliosis true science of Scoliosis measuring Cobb:definition method of X line of positive stand to lateral deviation curvature spinal deformity of 10°above, especially in patients with severe influence of teenagers, the physical and mental health. Scoliosis in adolescence, young even babies had scoliosis ratio is rising. But they are more teenagers and adults have greater risk:the development of eight to which will seriously impede breathing, influence cardiorespiratory function. Thus cause death. Young children scoliosis surgery, or an operation opportunities may be lost. Adolescent idiopathic scoliosis among the most common, pathogenesis unclear. With spinal pedicle screw internal fixation system, and the continuous improvement of 3d orthopaedic technology theory widely, scoliosis deformity effectively. Among them, some patients postoperative appeared decompensated phenomenon, it makes people aware of the need to a comprehensive and effective classification system for guidance. And that of other type system, effective guidance by the scoliosis orthopaedic surgery [10]. Various type has its unique characteristics, has also interconnected. How to distinguish the malformation type application characteristics, how to choose the correct fusion segments, scoliosis orthopaedic surgery.Research purposes1 system review scoliosis posterior fixation wires idiopathic scoliosis surgery clinical effects.2 that type system discussed in scoliosis posterior pedicle fixation wires and comparison of applied value in this type of orthodontic intraoperative significance.3 the correct selective fusion of patients with thoracic spinal corrective side protruding, research and analysis of clinical effect of vertebral fusion across the stage after the trunk.4 understanding and application of international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) were associated with health assessment and analysis of the quality of life.Research methods1 since September 2005 collected in December 2009-once in our line scoliosis posterior pedicle fixation nail orthod adolescent idiopathic spinal deformity,30 cases of 11 cases, women, men aged 19 cases,11-23 years, average age 14.2years old.1-5 years history,30 cases of idiopathic scoliosis. According to that type, type that I divided into 7 cases,10 cases II type, type III IV 8 cases,3 cases, V type 2 cases. Preoperative spinal deformity coronal Cobb Angle of 45°- 72°, on average,58.1°. Patients were followed up 6-28 months, average 1.64 months. According to the lateral bending the preoperative and postoperative follow-up, patients when light of X line and the standing coronary Cobb, overall Angle measurement outcomes.2 all cases that according to the application of system type, scoliosis patients using internal fixation of posterior pedicle screws orthopedic fusion surgery system. According to the guiding principle of the type that points to surgery patients, according to results of orthopaedic surgery and follow-up results will be 30 cases of analysis and evaluation of postoperative decompensated groups, analyzes on the operation that points.3 according to international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) for the Research of the 23 patients before and after the quality of life score.Research results 1 after all the cases were followed up 6-28 months, average 1.64 months. Preoperative coronal Cobb 58.1°Angle of average, on average, average 21.3°after corrective rate for 63.0%, Top vertebral shift from preoperative average 2.7 cm, average 1.1 cm, after an average rate of 78.9% kyphosis, Rotating malformation (Nash-Moe law) for theⅠ-Ⅲpreoperative and postoperative average orthopaedic I degree. Average height than preoperative 7cm. All patients and no spinal cord injuries, did not happen any loose nails, broken rod phenomenon, bone healing rate is high, reached the overall balance of spine. After a satisfactory with spinal healing, and keep the spinal motion, no certain crankshaft phenomenon and additional phenomenon, no other complications. Follow-up correction degrees lost 4.5 degrees.2 overall treatment:preoperative total 30 cases of existing coronal trunk lost balance and postoperative follow-up still seven terminal (25%).3 adopt international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) preoperative and postoperative quality of life score, found the posterior orthopaedic surgery patients from the heart, functional and quality of life for rational has been greatly improved.4 the chest curved correction result:30 patients with thoracic Cobb bending Angle of preoperative and postoperative average 58.1°, correct rate 63.0%21.3°, Preoperative compensatory Cobb bent on average range, after°Angle, correct rate 53.6% 17.5°research conclusion1 posterior spinal pedicle fixation system nail scoliosis wires to achieve good results.2 idiopathic scoliosis that type system can effectively guide orthopaedic surgery treatment, On the basis of correct classification, choosing the correct vertebral fusion range of surgical correction, moderately successful play more important role. 3 the international understanding and application of Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) may help us better understand oneself of preoperative and postoperative patients with self evaluation and quality of life.4 the effective integration of bone graft as soon as possible after achieved good results, and to prevent false joints, and given the strong fixation. In order to increase their ability to promote bone healing, bone graft更多还原