- 期刊
Upper Thoracic Curve Analysis in Idiopathic Thoracic Scoliosis Treated with Cotrel-Dubousset Or Harrington Rod Instrumentation
胸椎側彎症手術後上段胸椎角度變化之比較
摘要
哈靈頓桿(Harrington Rod)是最早被廣泛應用於矯正脊柱側彎的固定器,它有許多優點,但只能提供矢狀面的校正。悉第桿(Control-Dubousset Instrumentation)是近年來脊椎較興新的固定器，它能提供強有力的固定器在實際運用上，我們發現對於原因不明性胸椎側彎症手術後病人，兩肩部不平並未顯著改善，偶有更傾斜狀況，因此興起我們對於手術前後代償性上段胸椎柯布氏角度及第一胸椎斜度作一仔細評估。 本篇收集了台北榮民總醫院過去五年來有完整追蹤的39個病例，全部限定於青少年原因不明性胸椎側彎症，且只作主要胸椎骨融合的病例。其中24位接受哈靈頓桿矯正固定，15位接受悉第桿矯正固定。手術後發現具有完全兩段胸椎側彎症的病人(True Double Thoracic Curve)，即有正的第一胸椎斜率和較僵硬的上段胸椎，約50%易產生手術後左肩提高現象。另外我們也發現悉弟桿較哈靈頓桿易產生上段胸椎角度代償不良，縱使在上胸椎並不僵硬的情況下，也易因主要胸椎過度矯正，而產生頸部和兩肩的更不平衡。 因此在矯正青少年原因不明性胸椎側彎症的病人，我們建議手術前在臨床及X光片上須作仔細評估，及謹慎使用脊椎固定器。如果是屬於完全兩段胸椎側彎症病人，或是選用像悉弟桿像強有力的固定器，我們認為在做手術骨融合時，必須將兩段胸椎均包括進去，才能確保手術後外觀有滿意的結果。
關鍵字
無資料並列摘要
From January 1985 to June 1990, 53 patients with adolescent idiopathic thoracic scoliosis were treated with Harrington rod instrumentation (HRI) or Cotrel-Dubousset instrumentation (CDI). Thirty-nine patients had complete follow-up at an average of 2.8 years. Preoperative and postoperative analysis included Cobbangles of major thoracic curve (MTC) and upper thoracic curve(UTC),side bending flexibility, T1 obliquity and correctibility. Spinal decompensation after corrective surgery for scoliosis appears to be a significant problem after CDI. CDI produces torsional changes in the instrumented and uninstrumented spine that could result in spinal imbalance. Structural change of UTC had a substantially greater risk of imbalance. Failure to recognize the double thoracic pattern can lead to overcorrection of the MTC relative to the spontaneous flexibility of the upper curve. This results in an unbalanced correction with unsighlyshoulder elevation.
延伸閱讀
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