Y形软骨闭合与否对青少年特发性脊柱侧凸患者矫形疗效及并发症的影响

摘要

目的 探讨作为评估脊柱生长潜能指标的Y形软骨是否闭合对女性青少年特发性脊柱侧凸(AIS)患者单纯后路矫形内固定融合手术疗效及并发症的影响.方法 选取2003年6月至2007年10月行单纯后路矫形内固定融合术的女性胸弯AIS患者40例,其中手术时Y形软骨开放者16例(OTRC组),平均年龄11.8岁,冠状面主弯Cobb角平均53.3°,矢状面后凸平均27.7°;Y形软骨闭合者24例(CTRC组),平均年龄13.7岁,冠状面主弯Cobb角平均49.6°,矢状面后凸Cobb角平均27.8°.所有患者均于全身麻醉下行单纯后路矫形内固定融合术.对两组患者的术后及末次随访时冠状面胸主弯Cobb角、矢状面后凸Cobb角及并发症进行分析.结果 OTRC组和CTRC组术后平均随访27和26个月(P=0.74).两组患者术后平均Cobb角分别为22.2°和20.7°(P＝0.34),平均矫正率分别为58.3%和57.7%(P=0.83),末次随访时平均Cobb角为24.8°和21.1°(P＝0.05),平均矫正丢失率分别为5.3%和1.0%(P=0.01).矢状面上两组患者术后平均后凸Cobb角分别为22.5°和23.9°(P=0.49),平均矫正5.2°和3.9°(P=0.63),末次随访平均后凸Cobb角20.8°和24.7°(P＝0.04),平均丢失-1.7°和0.8°(P=0.01).OTRC组患者随访过程中出现冠状面Cobb角矫正丢失和矢状面后凸Cobb角减小.OTRC组2例实施选择性胸弯融合术的Lenke I型患者出现远端"附加现象",而CTRC组无远端"附加现象"发生.结论 Y形软骨是否闭合对女性AIS患者行单纯后路矫形内固定融合术短期疗效无明显影响,但OTRC组容易矫正丢失.OTRC或许是远端"附加现象"的危险因素.%Objective To investigate the effect of potential spinal growth on the posterior-only spinal instrumentation of adolescent idiopathic scoliosis (AIS) . Methods From June 2003 to October 2007 ,40 patients received posterior-only spinal instrumentation. Croup of open triradiate cartilage (Croup A) included 16 female AIS patients with mean age of 11. 8, and group of closed triradiate cartilages (Croup B)covered 24 female AIS patients with mean age of 13. 7. The mean preoperative Cobb angles of Croup A and B were S3. 3° and 49. 6° respectively, and the mean kyphosis in the sagittal plane was 27. 7° and 27. 8° respectively. Results The post-operative Cobb angles were 22. 2° (Group A) vs. 20. 7° (Group B) (P =0. 34) with correction rate of 58. 3% (Group A) vs. 57. 7% (Group B) (P = 0. 83). The mean Cobb angles at final follow-up were 24. 8°(Group A) vs. 21. l°(Group B) (P=0. 05) with the correction loss of 5.3% (Group A) vs. 1.0% (Group B) (P=0. 01). In the sagittal plane, the average post-operative kyphosis was 22. 5° (Group A) vs. 23. 9° (Group B) (P = 0.49) with correction of 5. 2° (Group A) vs.3.9°(GroupB) (P = 0.63). The mean kyphosis at final follow-up was 20. 8° (Group A) vs. 24.7°(Group B) (P=0.04) with the correction loss of - 1. 7°(Group A) vs. 0.8°(Group B)(P=0.01). Group A showed obvious correction loss in the coronal plane and decrease of kyphosis in the sagittal plane. Adding on phenomenon was found in 2 cases with Lenke type I with selected fusion in Group A, but not in Group B. Conclusions Although similar post-operative correction is found in AIS patients with OTRC or CTRC, the loss of correction and "adding on phenomenon" are more likely to happen in patients with OTRC.