Combined Mini-open Anterior Apical Vertebral Excision and Posterior Correction for Severe and Rigid Scoliosis_West China Medical Journal

Authors：

YANG Guanghui , ZHOU Chunguang , AN Yonggang , SONG Yueming , LIU Hao , LI Tao , GONG Quan ,  LIU Limin.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Limin., Email: yangguanghui1425@163.com

Keywords：

脊柱侧凸; 前路小切口; 顶椎切除; 后路矫形

DOI：

10.7507/1002-0179.20130311

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目的　探讨前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸的可行性及疗效。方法　2009 年7月－2010年9月，采用前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸18例。其中男9例，女9例，年龄10～24岁，平均14.5岁。其中15 例特发性脊柱侧凸（Lenke 2型6例，Lenke 3型1例，Lenke 4型8例），2 例脊髓空洞合并脊柱侧凸，1 例Chiari畸形合并脊柱侧凸。术前剃刀背高度（6.8 ± 2.3）cm，主胸弯Cobb角（99.6 ±10.0）°，主胸弯顶椎偏距（7.3 ± 1.3）cm。结果　前路手术切口10～13 cm，平均（11.4 ± 1.0）cm；前路手术时间170～300 min，平均（215.3 ± 36.8）min；失血量300～1 300 mL，平均（662.5 ± 274.8） mL。所有患者随访25～39个月，平均30.7个月。末次随访时，剃刀背高度（1.0 ± 0.6）cm，矫正率86.7%；主胸弯Cobb角（31.4 ± 11.4）°，矫正率68.7%；主胸弯顶椎偏距（2.2 ± 0.9） cm，矫正率69.6%。上胸弯、胸腰弯/腰弯的Cobb 角及顶椎偏距亦明显矫正，冠状面及矢状面平衡与术前相比，差异无统计学意义（P＞0.05）。未发生神经系统并发症，1例患者在前路手术后入ICU行呼吸支持治疗12 h，1例患者出现椎弓根螺钉穿透椎弓根上壁，2例患者出现钛网位置不佳，随访未见钛网位置改变。结论　采用前路小切口顶椎切除联合后路矫形治疗重度僵硬性脊柱侧凸安全可行，矫形效果满意。

Citation： YANG Guanghui,ZHOU Chunguang,AN Yonggang,SONG Yueming,LIU Hao,LI Tao,GONG Quan,LIU Limin.. Combined Mini-open Anterior Apical Vertebral Excision and Posterior Correction for Severe and Rigid Scoliosis. West China Medical Journal, 2013, 28(7): 1003-1007. doi: 10.7507/1002-0179.20130311 Copy

1.	Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity[J]. Clin Orthop Relat Res, 2010, 468(3): 687-699.
2.	Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis[J]. The Lancet, 2008, 371(9623): 1527-1537.
3.	Harding IJ, Chopin D, Charosky S, et al. Long-term results of Schollner costoplasty in patients with idiopathic scoliosis[J]. Spine (Phila Pa 1976), 2005, 30(14): 1627-1631.
4.	Bradford D. Vertebral column resection[J]. Orthop Trans, 1987, 11(6): 502-510.
5.	Byrd JA, 3rd, Scoles PV, et al. Adult idiopathic scoliosis treated by anterior and posterior spinal fusion[J]. Bone Joint Surgery Ame Vol, 1987, 69(6): 843-850.
6.	Shufflebarger HL, Grimm JO, Bui V, et al. Anterior and posterior spinal fusion. Staged versus same-day surgery[J]. Spine (Phila Pa 1976), 1991, 16(8): 930-933.
7.	Li M, Ni J, Li Y, et al. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China[J]. J Paediatr Child Health, 2009, 45(5): 246-253.
8.	Kuklo TR, Lenke LG, O’brien MF, et al. Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees[J]. Spine (Phila Pa 1976), 2005, 30(2): 222-226.
9.	Suk SI, Kim JH, Cho KJ, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation?[J]. Eur Spine J, 2007, 16(9): 1359-1365.
10.	Luhmann SJ, Lenke LG, Kim YJ, et al. Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary?[J]. Spine (Phila Pa 1976), 2005, 30(18): 2061-2067.
11.	Dobbs MB, Lenke LG, Kim YJ, et al. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees[J]. Spine (Phila Pa 1976), 2006, 31(20): 2386-2391.
12.	O’brien MF, Lenke LG, Bridwell KH, et al. Preoperative spinal canal investigation in adolescent idiopathic scoliosis curves ＞ or = 70 degrees[J]. Spine (Phila Pa 1976), 1994, 19(14): 1606-1610.
13.	Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (＞100 degrees)[J]. Spine (Phila Pa 1976), 2008, 33(9): 979-983.
14.	Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis[J]. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
15.	Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation[J]. Spine (Phila Pa 1976), 1997, 22(14): 1590-1599.
16.	Lenke LG, O’leary PT, Bridwell KH, et al. Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients[J]. Spine (Phila Pa 1976), 2009, 34(20): 2213-2221.
17.	Tokunaga M, Minami S, Kitahara H, et al. Vertebral decancellation for severe scoliosis[J]. Spine (Phila Pa 1976), 2000, 25(4): 469-474.
18.	Bullmann V, Halm HF, Schulte T, et al. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis[J]. Eur Spine J, 2006, 15(4): 440-448.

1. 　Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity[J]. Clin Orthop Relat Res, 2010, 468(3): 687-699.
2. 　Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis[J]. The Lancet, 2008, 371(9623): 1527-1537.
3. 　Harding IJ, Chopin D, Charosky S, et al. Long-term results of Schollner costoplasty in patients with idiopathic scoliosis[J]. Spine (Phila Pa 1976), 2005, 30(14): 1627-1631.
4. 　Bradford D. Vertebral column resection[J]. Orthop Trans, 1987, 11(6): 502-510.
5. 　Byrd JA, 3rd, Scoles PV, et al. Adult idiopathic scoliosis treated by anterior and posterior spinal fusion[J]. Bone Joint Surgery Ame Vol, 1987, 69(6): 843-850.
6. 　Shufflebarger HL, Grimm JO, Bui V, et al. Anterior and posterior spinal fusion. Staged versus same-day surgery[J]. Spine (Phila Pa 1976), 1991, 16(8): 930-933.
7. 　Li M, Ni J, Li Y, et al. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China[J]. J Paediatr Child Health, 2009, 45(5): 246-253.
8. 　Kuklo TR, Lenke LG, O’brien MF, et al. Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees[J]. Spine (Phila Pa 1976), 2005, 30(2): 222-226.
9. 　Suk SI, Kim JH, Cho KJ, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation?[J]. Eur Spine J, 2007, 16(9): 1359-1365.
10. 　Luhmann SJ, Lenke LG, Kim YJ, et al. Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary?[J]. Spine (Phila Pa 1976), 2005, 30(18): 2061-2067.
11. 　Dobbs MB, Lenke LG, Kim YJ, et al. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees[J]. Spine (Phila Pa 1976), 2006, 31(20): 2386-2391.
12. 　O’brien MF, Lenke LG, Bridwell KH, et al. Preoperative spinal canal investigation in adolescent idiopathic scoliosis curves ＞ or = 70 degrees[J]. Spine (Phila Pa 1976), 1994, 19(14): 1606-1610.
13. 　Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (＞100 degrees)[J]. Spine (Phila Pa 1976), 2008, 33(9): 979-983.
14. 　Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis[J]. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
15. 　Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation[J]. Spine (Phila Pa 1976), 1997, 22(14): 1590-1599.
16. 　Lenke LG, O’leary PT, Bridwell KH, et al. Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients[J]. Spine (Phila Pa 1976), 2009, 34(20): 2213-2221.
17. 　Tokunaga M, Minami S, Kitahara H, et al. Vertebral decancellation for severe scoliosis[J]. Spine (Phila Pa 1976), 2000, 25(4): 469-474.
18. 　Bullmann V, Halm HF, Schulte T, et al. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis[J]. Eur Spine J, 2006, 15(4): 440-448.

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