• 解放軍總醫(yī)院骨科（北京，100853）;

目的探討在特發(fā)性脊柱側(cè)凸（idiopathic scoliosis，IS）后路矯形手術(shù)中，多節(jié)段Ponte截骨術(shù)對保持和恢復(fù)胸椎后凸的作用。 方法回顧分析2008年3月－2010年2月收治的42例采用脊柱后路椎弓根釘棒系統(tǒng)矯治的Lenke 1型IS患者，按照術(shù)中脊柱后方結(jié)構(gòu)松解方式不同分為A、B兩組。A組17例采用多節(jié)段Ponte截骨術(shù)，截骨部位均選擇在胸彎頂椎附近連續(xù)3個節(jié)段；B組25例采用單純軟組織松解術(shù)。兩組患者性別、年齡、病程、病變累及節(jié)段、冠狀面Cobb角、胸椎后凸角、Risser指數(shù)及側(cè)方彎曲像柔韌度比較差異均無統(tǒng)計學(xué)意義（P  gt; 0.05），具有可比性。手術(shù)前后攝脊柱站立正側(cè)位X線片并記錄相關(guān)臨床資料，比較兩組手術(shù)效果。 結(jié)果所有手術(shù)均順利完成。A組手術(shù)時間和術(shù)中失血量均顯著大于B組，差異有統(tǒng)計學(xué)意義（P  lt; 0.05）。A組術(shù)中1例發(fā)生硬膜損傷、腦脊液漏，術(shù)后俯臥、切口加壓后自行愈合；其余患者均未發(fā)生術(shù)中相關(guān)并發(fā)癥。所有患者均獲隨訪，隨訪時間2～4年，平均2.8年。均無神經(jīng)損傷、感染和內(nèi)固定失敗等并發(fā)癥發(fā)生。術(shù)后無明顯矯形丟失，外觀和軀干平衡均明顯改善。A、B組術(shù)后1周及2年主胸彎冠狀面Cobb角均較術(shù)前明顯改善（P  lt; 0.05）；術(shù)后1周及2年間比較差異無統(tǒng)計學(xué)意義（P  gt; 0.05）。A組術(shù)后1周及2年冠狀面Cobb角及矯正率與B組比較差異無統(tǒng)計學(xué)意義（P  gt; 0.05）。A組術(shù)后1周及2年的胸椎后凸角及角度改變均優(yōu)于B組，差異有統(tǒng)計學(xué)意義（P  lt; 0.05）。 結(jié)論在Lenke 1型IS后路矯形手術(shù)中，通過多節(jié)段Ponte截骨術(shù)，在矢狀面能夠有效保持和恢復(fù)胸椎后凸，在冠狀面對矯正率無明顯影響。

引用本文： 張國瑩,張永剛,張雪松,王征,毛克亞,王巖. 特發(fā)性脊柱側(cè)凸多節(jié)段Ponte截骨術(shù)對恢復(fù)胸椎后凸的療效. 中國修復(fù)重建外科雜志, 2012, 26(10): 1197-1201. doi: 復(fù)制

1. Hayashi K, Upasani VV, Pawelek JB, et al. Three-dimensional analysis of thoracic sagittal alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2009, 34(8): 792-797.
2. Newton PO, Faro FD, Gollogly S, et al. Results of preoperati ve Pulmonary function testing of adolescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. J Bone Joint Surg (Am), 2005, 87(9): 1937-1946.
3. Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2010, 35(14): 1365-1370.
4. Graham EJ, Lenkc LG, Lowe TG, et al. Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2000, 25(18): 2319-2325.
5. Newton PO, Marks M, Faro F, et al. Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine (Phila Pa 1976), 2003, 28(20): S249-S254.
6. Faro FD, Marks MC, Newton PO, et al. Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic versus open approaches. Spine (Phila Pa 1976), 2005, 30(9): 1058-1063.
7. Imrie M, Yaszay B, Bastrom TP, et al. Adolescent idiopathic scoliosis: should 100% correction be the goal? J Pediatr Orthop, 2011, 31(1 Suppl): S9-13.
8. Suk SI, Kim WJ, Kim JH, et al. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord, 1999, 12(6): 489-495.
9. Suk SI, Lee SM, Chung ER, et al. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976), 2003, 28(5): 484-491.
10. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2006, 31(3): 291-298.
11. Lowenstein JE, Matsumoto H, Vitale MG, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976), 2007, 32(4): 448-452.
12. Clement JL, Chau E, Kimkpe C, et al. Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine (Phila Pa 1976), 2008, 33(14): 1579-1587.
13. Mladenov KV, Vaeterlein C, Stuecker R. Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment. Eur Spine J, 2011, 20(7): 1114-1117.
14. Qiu Y, Zhu F, Wang B, et al. Comparison of surgical outcomes of lenke type 1 idiopathic scoliosis: vertebral coplanar alignment versus derotation technique. J Spinal Disord Tech, 2011, 24(8): 492-499.
15. Geck MJ, Macagno A, Ponte A, et al. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech, 2007, 20(8): 586-593.
16. Shufflebarger HL, Clark CE. Effect of wide posterior release on correction in adolescent idiopathic scoliosis. J Pediatr Orthop B, 1998, 7(2): 117-123.
17. Shufflebarger HL, Geck MJ, Clark CE. The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976), 2004, 29(3): 269-276.
18. Halanski MA, Cassidy JA. Do multilevel ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? J Spinal Disord Tech, 2011. [Epub ahead of print].
19. Fletcher ND, Hopkins J, McClung A, et al. Residual thoracic hypokyphosis following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications. Spine (Phila Pa 1976), 2012, 37(3): 200-206.
20. Suk SI. Pedicle screw instrumentation for adolescent idiopathic scoliosis: the insertion technique, the fusion levels and direct vertebral rotation. Clin Orthop Surg, 2011, 3(2): 89-100.
  1. 1. Hayashi K, Upasani VV, Pawelek JB, et al. Three-dimensional analysis of thoracic sagittal alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2009, 34(8): 792-797.
  2. 2. Newton PO, Faro FD, Gollogly S, et al. Results of preoperati ve Pulmonary function testing of adolescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. J Bone Joint Surg (Am), 2005, 87(9): 1937-1946.
  3. 3. Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2010, 35(14): 1365-1370.
  4. 4. Graham EJ, Lenkc LG, Lowe TG, et al. Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2000, 25(18): 2319-2325.
  5. 5. Newton PO, Marks M, Faro F, et al. Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine (Phila Pa 1976), 2003, 28(20): S249-S254.
  6. 6. Faro FD, Marks MC, Newton PO, et al. Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic versus open approaches. Spine (Phila Pa 1976), 2005, 30(9): 1058-1063.
  7. 7. Imrie M, Yaszay B, Bastrom TP, et al. Adolescent idiopathic scoliosis: should 100% correction be the goal? J Pediatr Orthop, 2011, 31(1 Suppl): S9-13.
  8. 8. Suk SI, Kim WJ, Kim JH, et al. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord, 1999, 12(6): 489-495.
  9. 9. Suk SI, Lee SM, Chung ER, et al. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976), 2003, 28(5): 484-491.
  10. 10. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2006, 31(3): 291-298.
  11. 11. Lowenstein JE, Matsumoto H, Vitale MG, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976), 2007, 32(4): 448-452.
  12. 12. Clement JL, Chau E, Kimkpe C, et al. Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine (Phila Pa 1976), 2008, 33(14): 1579-1587.
  13. 13. Mladenov KV, Vaeterlein C, Stuecker R. Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment. Eur Spine J, 2011, 20(7): 1114-1117.
  14. 14. Qiu Y, Zhu F, Wang B, et al. Comparison of surgical outcomes of lenke type 1 idiopathic scoliosis: vertebral coplanar alignment versus derotation technique. J Spinal Disord Tech, 2011, 24(8): 492-499.
  15. 15. Geck MJ, Macagno A, Ponte A, et al. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech, 2007, 20(8): 586-593.
  16. 16. Shufflebarger HL, Clark CE. Effect of wide posterior release on correction in adolescent idiopathic scoliosis. J Pediatr Orthop B, 1998, 7(2): 117-123.
  17. 17. Shufflebarger HL, Geck MJ, Clark CE. The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976), 2004, 29(3): 269-276.
  18. 18. Halanski MA, Cassidy JA. Do multilevel ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? J Spinal Disord Tech, 2011. [Epub ahead of print].
  19. 19. Fletcher ND, Hopkins J, McClung A, et al. Residual thoracic hypokyphosis following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications. Spine (Phila Pa 1976), 2012, 37(3): 200-206.
  20. 20. Suk SI. Pedicle screw instrumentation for adolescent idiopathic scoliosis: the insertion technique, the fusion levels and direct vertebral rotation. Clin Orthop Surg, 2011, 3(2): 89-100.