文章摘要
张宏其,邓盎,郭超峰,唐明星,刘少华,王昱翔,高琪乐,刘金洋.短钉多点锚定与钉钩混合系统矫治神经纤维瘤病脊柱侧凸的比较[J].,2019,27(17):1537-1542
短钉多点锚定与钉钩混合系统矫治神经纤维瘤病脊柱侧凸的比较
Multiple-pointanchoringwithshortscrewversushybridinstrumentationfordystrophicscoliosissecondaryto
投稿时间:2019-03-15  修订日期:2019-04-02
DOI:
中文关键词: 神经纤维瘤病,营养不良性脊柱侧凸,多点锚定,钉钩混合系统
英文关键词: 
基金项目:
作者单位
张宏其  
邓盎  
郭超峰  
唐明星  
刘少华  
王昱翔  
高琪乐  
刘金洋  
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中文摘要:
      摘要:[目的]比较后路短钉多点锚定与钉钩混合系统矫治Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的疗效。[方法]回顾性分析2005年~2017年手术治疗的Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸患者42例,其中,21例采用后路短钉多点锚定钉棒系统矫治,21例采用钉钩混合系统矫治。比较两组手术时间、出血量、融合节段数;影像测量冠状面Cobb角、顶椎偏距、顶椎旋转度、矢状面后凸。[结果]两组患者均顺利手术,均未出现神经、血管损伤等严重并发症。多点锚定组手术时间稍长、术中出血量稍多于混合系统组,但差异无统计学意义(P>005)。平均随访时间多点锚定组(39.75±20.06)个月,混合系统组(34.50±13.77)个月,两组患者一般情况好,患者外形、躯干平衡较术前明显改善。影像学评估方面,两组患者术后和末次随访时主弯冠状面侧凸Cobb角、顶椎偏距、顶椎旋转度、矢状面后凸Cobb角均较术前显著减少,差异有统计学意义(P<0.05)。多点锚定组在术后即刻和末次随访时的主弯冠状面Cobb角、顶椎偏距、顶椎旋转度均小于混合系统组,差异有统计学意义(P<0.05)。多点锚定组矫正丢失率为(2.20±2.21)%,而混合系统组为(3.57±1.40)%。[结论]对Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的矫治,短钉多点锚定与钉钩混合系统均可获得较满意的矫形融合效果,而短钉多点锚定的畸形矫正率更高,矫正丢失率更低。
英文摘要:
      Abstract:[Objective]Tocomparetheclinicalandradiographicoutcomesbetweenmultiple-pointanchoringwithshortscrewinpediclescrew-rodsystemandhybridinstrumentationfortreatmentofdystrophicscoliosissecondarytoneurofibromato?sistype-1.[Methods]From2005to2017,atotalof42patientswithdystrophicscoliosissecondarytoneurofibromatosistype-1underwentsurgicaltreatmentinourdepartment.Basedoninstrumentationused,21patientshadspinaldeformitycorrectedwith multiple-pointanchoringbyshortscrewinpediclescrew-rodsystem,whiletheremaining21patientsreceivedinternalfixation withahybridinstrumentationcombinedscrewwithhook.Theoperationtime,intraoperativebloodloss,segmentsfusedandparametersradiographicallymeasured,suchascoronalCobbangleofmaincurve,apicalvertebraltranslation(AVT),apicalverte?bralrotation(AVR),sagittalkyphosis(SK)werecomparedbetweenthetwogroups.[Results]Allthepatientshadsurgicalpro?ceduresperformedsmoothlywithoutseriouscomplication,suchasneurovascularinjuries.Themultiple-pointanchoringgroupsconsumedlongeroperationtime,associatedwithmoreintraoperativebloodlossthanthehybridinstrumentationgroup,althoughthedifferenceswerenotstatisticallysignificant(P>0.05).Duringthefollow-upperiod,allthepatientsinbothgroupswereinagoodgeneralcondition,andachievedremarkableimprove?mentinbodyconfiguration,withapropertrunkbalancecom?paredwiththosebeforeoperation.Intermofradiographicas?sessment,thecoronalCobbangle,AVT,AVR,andSKimme?diatelyafteroperationandatthelatestfollowupsignificantlydecreasedinbothgroupscomparedwiththosepreoperatively(P<0.05).Themultiple-pointanchoringgroupsprovedsignif?icantlylesscoronalCobbangle,AVT,AVRimmediatelyafteroperationandatthelatestfollowupthanthehybridinstrumentationgroup(P<0.05).ThecorrectionlossrateinthecoronalCobbanglebetweenthetimepointsimmediatelyafteroperationandthelatestfollowupprovedof(2.20±2.21)%inthemulti?ple-pointanchoringgroups,whereas(3.57±1.40)%inthehybridinstrumentationgroup.[Conclusion]Boththemultiple-pointanchoringbyshortscrewandhybridinstrumentationachievesatisfactoryclinicaloutcomesfordystrophicscoliosissecondarytoneurofibromatosistype-1.Bycomparison,themultiple-pointanchoringbyshortscrewprovidedasignificantlybettercorrectionwithlowercorrectivelossthanthehybridinstrumentation.
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