【摘要】 [目的]比较Lenke 5C青少年特发性脊柱侧凸(AIS)采用VCM技术(vertebral column manipulator)和旋棒技术(RD,rod derotation)矫正的临床效果。[方法]回顾性分析本院脊柱侧弯中心2008年7月~2012年8月收治的36例Lenke 5C AIS患者,按去旋转矫正技术不同分为2组:VCM组26例,RD组15例,所有患者皆具有完整临床和影像资料。研究测量记录患者的10项影像参数,包括主弯顶椎旋转角及其矫正率,主弯Cobb角及其矫正率,主弯顶椎偏移(AVT),C7铅垂线偏移骶骨中央垂线距离(C7-CSVL),C7铅垂线偏移骶骨后上角距离(C7-SSVL),下融合椎倾斜角(LIV-tilt)及其矫正率,下融合椎距稳定椎节段数(LIV-SV),并利用统计学独立样本t检验对两组病例术前、术后的影像参数进行比较。[结果]两组患者皆成功获得手术矫正,术中、术后无严重并发症发生。VCM组和RD组的顶椎旋转角旋转矫正率平均为52.2%和34.4%,两组术前顶椎旋转角无统计学差异(P>0.05),术后顶椎旋转角及旋转矫正率具有明显统计学差异(P<0.05);两组的主弯Cobb角矫正率平均为87.3%和82.4%,两组间无统计学差异(P>0.05);两组的LIV-SV具有明显统计学差异(P<0.05),VCM组明显大于RD组,其均值分别为(1.1±0.3)节和(0.8±0.4)节;两组的LIV-tilt角矫正率平均为77.2%和66.6%,组间无明显统计学差异(P>0.05);两组患者术前、术后的冠状面和矢状面平衡皆得到良好维持。[结论]Lenke 5C AIS采用VCM技术和旋棒技术矫形皆可获得良好的主弯和下融合椎倾斜角矫正及冠状面和矢状面平衡,但VCM技术术后即刻的顶椎旋转矫正和减少腰椎远端融合节段的趋势优于旋棒技术。更多还原

【Abstract】 [Objective] To evaluate the radiographic outcomes of Lenke 5C patients treated by vertebral column manipulator( VCM) and rod derotation( RD) maneuver. [Methods] A retrospective study was designed to compare 2 cohorts including 36 Lenke V patients treated by VCM and SRD techniques from July 2008 to Aug 2012. In VCM group,there were 24 AIS patients,who were male 5 and female 19,with mean age( 15. 7 ± 3. 4) years. In RD group,12 AIS patients who were male 3 and female 9,with mean age( 17. 1 ± 3. 4) years. All patients had completed record and whole spine PA and lateral X- ray film before and after operation,Ten radiographic variables of pre- operation and post- operation were collected and compared between two groups,including apical rotational angle and rotational corrective rate of main curve,Cobb angle and curve corrective rate of main curve,coronal C 7 to center sacral vertical line( C 7- CSVL),the sagittal C 7 to center sacral vertical line( C 7- SSVL), apical vertebral transition( AVT),lowest instrumented vertebra tilt( LIV- Tilt) angle and LIV- Tilt corrective rate,the segmental number between LIV and stable vertebra,and the segment between LIV and SV( LIV- SV). [Results] Scoliosis was successfully corrected in both groups. All patients got good coronal,sagittal balance and no severe complications happened during or after operation. The apical rotation corrective rate of VCM group and RD group were 52. 2% and 34. 4%,with statistically significant differences( P < 0. 05). Main curve corrective rate of both groups were 87. 3% and 82. 4%,without significant difference( P > 0. 05). The LIV- SV had statistically significant differences between VCM and RD group,mean were( 1. 1 ± 0. 3) level and( 0. 8 ± 0. 4) level( P > 0. 05). LIV- tilt angle correction rate of both groups had no statistically significant difference,but the the VCM group’s correction rate was higher than the 01 RD group( VCM group : RD group = 77. 2% : 66. 6%). Moreover,the coronal and sagittal balance was well maintained between both groups. [Conclusion] VCM technique can improve radiographic axial rotational angle of apical vertebra than RD technique in Lenke 5C patients,and can significantly shorten the lumbar fusion segment.更多还原