退行性脊柱侧凸的融合节段选择与躯干平衡

2014-07-03   文章来源:中国脊柱侧凸年会    点击量:1123 我要说

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专题组织人:陈其昕教授
  长期以来,如何选择退行性脊柱侧凸的融合范围仍然没有公认的原则,存在很大的争议[1-4]。多数学者认为理想的近端融合椎应在冠状面及矢状面上均保持稳定、中立水平,也有一些研究表明胸腰段为脊柱力学转折点,生物力学上处于不稳,有较高的融合失败率,不予推荐[2-5]。远端融合椎选择L5还是S1是争议最大的问题,融合至L5可以减少手术时间,降低手术风险,保留腰骶部的活动功能,降低假关节的发生率,降低内固定相关并发症,但是会导致L5/S1椎间盘退变加速;融合至S1可以减少L5椎弓根钉拔出、松动的发生率,防止脊柱滑脱,消除L5/S1继发退变,但是手术时间常,出血量多,术后感染发生率高,L5/S1假关节发生率高,还会引起骶髂关节退变及步态改变[2, 6-10]。矢状面平衡与成人脊柱畸形疗效密切相关,但是,冠状面的平衡对其影响尚不明确[11],邱勇等[12, 13]提出了冠状面分型系统及相应的截骨方式,不仅得到了更好的冠状面平衡,还使外观得到满意的改善。因此,在选择手术方案时,对于上、下融合端椎我们究竟该如何选择,恢复矢状面平衡时是否也要考虑到冠状面的平衡问题呢?
References:
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[12]. 邱勇,退变性脊柱侧凸的分型与治疗. 中国骨与关节杂志, 2013(10): 第541-545页.
[13]. 邱勇等,退变性腰椎侧凸的冠状面失衡分型及对截骨矫形术式选择的意义. 中华骨科杂志, 2009(5): 第418-423页.

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发表于:2014-07-23 01:07:52  IP:221.7.8.182