全椎弓根螺钉一期后路手术治疗重度脊柱侧凸畸形

目的探讨全椎弓根螺钉一期后路手术治疗重度（Cobb角≥90°）脊柱侧凸的临床应用价值.方法随机收集2008年以前先经前路松解,后期经后路椎弓根螺钉或钩固定手术（A组29例）和2008年以后采用全椎弓根螺钉一期后路手术（B组29例）治疗的重度脊柱侧凸患者的完整资料,比较两组手术前后及末次随访时Cobb角、手术时间、术中出血量、住院费用和SRS-24评分的差异.结果 A组主弯Cobb角由（96.3±4.7）°矫正到（28±4.5）°,术后矫正率为（69.5%±4.1）%,B组主弯Cobb角由（98.4±5.8）°矫正到（25±3.7）°,术后矫正率为（72.3%±3.5）%.两组影像学资料比较无统计学意义（P〉0.05）.A组手术时间、术中出血量、住院费用及SRS评分分别为（350.4±38.7）min,（2 210±165）mL,（94 230.8±3 422.1）和（17.54±0.20）min;B组分别为（253.0±30.7）min,（1210±185）mL,（75 620.8±5432.1）元,（19.74±0.30）min,两组间差异有统计学意义（P〈0.05）.结论采用全椎弓根螺钉一期后路手术治疗任何病因的重度脊柱侧凸畸形的临床应用价值在于省略前路脊柱松解术,手术风险小,并发症与满意度高且住院费用相对低等优点.

One-step Posterior Spinal Screw Fixation of Whole Pedicle of Vertebral Arch in Treatment of Sever Scoliosis

Objective To analyze the effects and clinical application values of one-step screw fixation of whole posterior pedicle of vertebral arch in treatment of severe scoliosis（Cobb angle 90°）.Methods Clinical data were collected for anterior spinal release together with posterior spinal screw fixation of whole pedicle of vertebral arch（group A with 29 patients）before 2008 and one-step posterior spinal screw fixation operation of whole pedicle of vertebral arch（group B with 29 patients）in treatment of patients with severe scoliosis in our hospital.The clinical effects were evaluated by comparing Cobb angle changes,operation time,blood loss,treatment cost and SRS-22 score between the two groups.Results In group A,the major-curve Cobb angle was preoperatively 96.3±4.7 °and decreased to 28°±4.5° postoperatively,the average major correction was（69.5±4.1）%;In group B,the major-curve Cobb angle decreased from 98.4±5.8 °to 25°±3.7°,the average major correction rate was 72.3%±3.5%.There was no statistical significant difference in the parameters of imageology between the two groups（P0.05）.The operation time,blood loss,treatment cost and the SRS-24 score in group A were 350.4±38.7 min,2210±165 mL,94230.8±3422.1 RMB and 17.54±0.20,and in group B were 253.0±30.7 min,1210±185 mL,75620.8±5432.1 RMB and 19.74±0.30,respectively.There were statistical significant differences between the two groups for above data（P0.05）.Conclusion One-step posterior spinal screw fixation of whole pedicle of vertebral arch in treatment of various sever scoliosis has the advantages of abbreviation of anterior spinal release procedure,decrease of operative risks,reduction of surgical expense and less complications.