• 四川大學(xué)華西醫(yī)院骨科（成都，610041）;

【摘 要】 目的 對(duì)重度僵硬性脊柱側(cè)凸矯正技術(shù)的進(jìn)展進(jìn)行綜述。 方法 查閱近年來(lái)國(guó)內(nèi)外重度僵硬性脊
柱側(cè)凸的相關(guān)文獻(xiàn)，總結(jié)重度僵硬性脊柱側(cè)凸矯正技術(shù)的最新進(jìn)展。 結(jié)果 重度僵硬性脊柱側(cè)凸矯正技術(shù)有如下進(jìn)展：
Halo- 重力牽引應(yīng)用增多；嘗試了后路矯形術(shù)中應(yīng)用Halo- 股骨髁上牽引；全椎弓根螺釘固定矯形技術(shù)逐步得到推廣；經(jīng)
后路全脊椎切除技術(shù)、一期前后路手術(shù)及單純后路矯形手術(shù)應(yīng)用增多。 結(jié)論 各種矯形技術(shù)的進(jìn)展顯著提高了重度僵
硬性脊柱側(cè)凸的矯形效果，但目前尚無(wú)標(biāo)準(zhǔn)化治療方案，未來(lái)可期待更顯著的進(jìn)展。

引用本文： 周春光,宋躍明. 重度僵硬性脊柱側(cè)凸矯正技術(shù)進(jìn)展. 中國(guó)修復(fù)重建外科雜志, 2012, 26(2): 238-243. doi: 復(fù)制

1. 李明, 劉洋, 朱曉東, 等. 一期前路松解后路三維矯形治療重度僵硬性脊柱側(cè)凸. 中華骨科雜志, 2004, 24(5): 271-275.
2. Greiner KA. Adolescent idiopathic scoliosis: radiologic decision-making. Am Fam Physician, 2002, 65(9): 1817-1822.
3. Yong Q, Zhen L, Feng Z, et al. Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis: a retrospective study. J Orthop Surg, 2007, 2: 23.
4. Dobbs MB, Lenke LG, Kim YJ, et al. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees. Spine (Phila Pa 1976), 2006, 31(20): 2386-2391.
5. Kuklo TR, Lenke LG, O’Brien MF, et al. Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees. Spine (Phila Pa 1976), 2005, 30(2): 222-226.
6. Watanabe K, Lenke LG, Bridwell KH, et al. Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (>/=100 degrees). J Orthop Sci, 2010, 15: 720-730.
7. 朱鋒, 邱勇, 王斌, 等. Halo輪椅懸吊重力牽引在嚴(yán)重脊柱側(cè)后凸兒童術(shù)前的應(yīng)用價(jià)值. 中國(guó)脊柱脊髓雜志, 2010, 20(7): 549-553.
8. Rinella A, Lenke L, Whitaker C, et al. Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine (Phila Pa 1976), 2005, 30(4): 475-482.
9. Mehlman CT, Sayyad MJ, Crawford AH. Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity. J Pediatr Orthop, 2004, 24(6): 667-673.
10. Sponseller PD, Takenaga RK, Newton P, et al. The use of traction in the treatment of severe spinal deformity. Spine (Phila Pa 1976), 2008, 33(21): 2305-2309.
11. Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis. (>100 degrees). Spine (Phila Pa 1976), 2008, 33(9): 979-983.
12. Zhang HQ, Wang YX, Guo CF, et al. Posterior-only surgery with strong halo-femoral traction for the treatment of adolescent idiopathic scoliotic curves more than 100°. Int Orthop, 2011, 35(7): 1037-1042.
13. 張宏其, 王永福, 唐明星, 等. 牽引結(jié)合后路手術(shù)治療重度脊柱側(cè)凸的療效分析. 中國(guó)矯形外科雜志, 2009, 17(21): 1617-1620.
14. Suk SI, Kim JH, Cho KJ, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation? Eur Spine J, 2007, 16(9): 1359-1365.
15. Luhmann SJ, Lenke LG, Kim YJ, et al. Financial analysis of circumferential fusion versus posterior-only with thoracic pedicle screw constructs for main thoracic idiopathic curves between 70 degrees and 100 degrees. J Child Orthop, 2008, 2(2): 105-112.
16. 賈全章, 孫景海, 侯明曉, 等. 凹側(cè)雙棒全椎弓根螺釘技術(shù)對(duì)提高重度僵硬性特發(fā)性脊柱側(cè)凸矯治效果的作用. 解放軍醫(yī)學(xué)雜志, 2009, 34(6): 683-685.
17. Modi HN, Suh SW, Hong JY, et al. Accuracy of thoracic pedicle screw using ideal pedicle entry point in severe scoliosis. Clin Orthop Relat Res, 2010, 468(7): 1830-1837.
18. 王冰, 呂國(guó)華, 陳瑞松, 等. 重度特發(fā)性脊柱側(cè)凸胸椎椎弓根螺釘徒手置入精確性的CT評(píng)價(jià). 中南大學(xué)學(xué)報(bào): 醫(yī)學(xué)版, 2009, 34(3): 226-229.
19. Wang Y, Zheng G, Zhang X, et al. Comparative analysis between shape memory alloy-based correction and traditional correction technique in pedicle screws constructs for treating severe scoliosis. Eur Spine J, 2010, 19(3): 394-399.
20. Rosales LM, Miramontes V, Reyes AS. External fixation for dynamic correction of severe scoliosis. Spine J, 2005, 5(4): 418-426.
21. Bullmann V, Halm HF, Schulte T, et al. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. Eur Spine J, 2006, 15(4): 440-448.
22. Suk SI, Kim JH, Chung ER, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
23. Lenke LG, O’leary PT, Bridwell KH, et al. Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine (Phila Pa 1976), 2009, 34(20): 2213-2221.
24. Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010, 468(3): 687-699.
25. Hamzaoglu A, Alanay A, Ozturk C, et al. Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine (Phila Pa 1976), 2011, 36(5): E340-E344.
26. Matsumoto M, Watanabe K, Tsuji T, et al. Progressive kyphoscoliosis associated with tethered cord treated by posterior vertebral column resection: a case report. Spine (Phila Pa 1976), 2009, 34(26): E965-E968.
27. Smith JS, Wang VY, Ames CP. Vertebral column resection for rigid spinal deformity. Neurosurgery, 2008, 63(3 Suppl): 177-182.
28. Nepple JJ, Lenke LG. Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy. Spine J, 2009, 9(7): e9-e13.
29. Xie J, Wang Y, Zhao Z, et al. One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary? Eur spine J, 2011, 20(7): 1106-1113.
30. 郭海龍, 鄭新峰, 盛偉斌, 等. 后路楔形截骨治療僵硬性脊柱側(cè)彎．中國(guó)修復(fù)重建外科雜志, 2010, 24(7): 885-888．.
31. 李超, 周宇, 付青松, 等. 經(jīng)后路胸膜外松解脊椎楔形截骨治療重度特發(fā)性脊柱側(cè)凸. 中國(guó)脊柱脊髓雜志, 2009, 19(3): 182-187．.
32. 李超, 付青松, 周宇, 等. 一期胸腰椎兩處截骨治療重度先天性脊柱側(cè)凸并脊髓拴系綜合征. 中國(guó)脊柱脊髓雜志, 2010, 20(12): 1003-1007.
33. Bakaloudis G, Lolli F, Di MS, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20(Suppl 1): S95-104.
34. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of smith-petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2037.
35. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-S178.
36. Sucato DJ. Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976), 2010, 35(25): 2186-2192.
37. Diab MG, Franzone JM, Vitale MG. The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique. J Pediatr Orthop, 2011, 31(1 Suppl): S88-S98.
38. Suh SW, Modi HN, Yang J, et al. Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis: a preliminary study. Spine (Phila Pa 1976), 2009, 34(12): 1315-1320.
39. Modi HN, Suh SW, Hong JY, et al. Posterior multilevel vertebral osteotomy for severe and rigid idiopathic and nonidiopathic kyphoscoliosis: a further experience with minimum two-year follow-up. Spine (Phila Pa 1976), 2011, 36(14): 1146-1153.
40. Wang Y, Mao K, Xiao S, et al. Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot study. Eur Spine J, 2010, 19(5): 797-802.
41. Wu Z, Huang L, Sang H, et al. Accuracy and safety assessment of pedicle screw placement using the rapid prototyping technique in severe congenital scoliosis, 2010.
42. Yang JC, Ma XY, Lin J, et al. Personalised modified osteotomy using computer-aided design-rapid prototyping to correct thoracic deformities. Int Orthop, 2011, 35(12): 1827-1832.
43. Shen J, Qiu G, Wang Y, et al. Comparison of 1-stage versus 2-stage anterior and posterior spinal fusion for severe and rigid idiopathic scoliosis—a randomized prospective study. Spine (Phila Pa 1976), 2006, 31(22): 2525-2528.
44. Li M, Ni J, Li Y, et al. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in china. J Paediatr Child Health, 2009, 45(5): 246-253.
45. Sucato DJ, Erken YH, Davis S, et al. Prone thoracoscopic release does not adversely affect pulmonary function when added to a posterior spinal fusion for severe spine deformity. Spine (Phila Pa 1976), 2009, 34(8): 771-778.
46. Mirzanli C, Ozturk C, Karatoprak O, et al. Double-segment total vertebrectomy for the surgical treatment of congenital kyphoscoliosis: a case report. Spine J, 2008, 8(4): 683-686.
47. Lonner BS, Murthy SK, Boachie OA. Single-staged double anterior and posterior spinal reconstruction for rigid adult spinal deformity: a report of four cases. Spine J, 2005, 5(1): 104-108.
48. 張宏其, 魯世金, 陳靜, 等. 廣泛后路松解三維矯形治療重度特發(fā)性脊柱側(cè)凸. 中國(guó)脊柱脊髓雜志, 2007, 17(4): 274-279.
49. 馬華松, 周建偉, 鄒德威, 等. 重度僵硬型脊柱側(cè)凸的后路非全椎體截骨手術(shù)治療. 中國(guó)矯形外科雜志, 2010, 18(16): 1323-1326．.
50. 馬華松, 鄒德威, 周建偉, 等. 重度脊柱側(cè)后凸畸形的后路分期手術(shù)治療. 中國(guó)脊柱脊髓雜志, 2009, 19(8): 588-592.
  1. 1. 李明, 劉洋, 朱曉東, 等. 一期前路松解后路三維矯形治療重度僵硬性脊柱側(cè)凸. 中華骨科雜志, 2004, 24(5): 271-275.
  2. 2. Greiner KA. Adolescent idiopathic scoliosis: radiologic decision-making. Am Fam Physician, 2002, 65(9): 1817-1822.
  3. 3. Yong Q, Zhen L, Feng Z, et al. Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis: a retrospective study. J Orthop Surg, 2007, 2: 23.
  4. 4. Dobbs MB, Lenke LG, Kim YJ, et al. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees. Spine (Phila Pa 1976), 2006, 31(20): 2386-2391.
  5. 5. Kuklo TR, Lenke LG, O’Brien MF, et al. Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees. Spine (Phila Pa 1976), 2005, 30(2): 222-226.
  6. 6. Watanabe K, Lenke LG, Bridwell KH, et al. Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (>/=100 degrees). J Orthop Sci, 2010, 15: 720-730.
  7. 7. 朱鋒, 邱勇, 王斌, 等. Halo輪椅懸吊重力牽引在嚴(yán)重脊柱側(cè)后凸兒童術(shù)前的應(yīng)用價(jià)值. 中國(guó)脊柱脊髓雜志, 2010, 20(7): 549-553.
  8. 8. Rinella A, Lenke L, Whitaker C, et al. Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine (Phila Pa 1976), 2005, 30(4): 475-482.
  9. 9. Mehlman CT, Sayyad MJ, Crawford AH. Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity. J Pediatr Orthop, 2004, 24(6): 667-673.
  10. 10. Sponseller PD, Takenaga RK, Newton P, et al. The use of traction in the treatment of severe spinal deformity. Spine (Phila Pa 1976), 2008, 33(21): 2305-2309.
  11. 11. Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis. (>100 degrees). Spine (Phila Pa 1976), 2008, 33(9): 979-983.
  12. 12. Zhang HQ, Wang YX, Guo CF, et al. Posterior-only surgery with strong halo-femoral traction for the treatment of adolescent idiopathic scoliotic curves more than 100°. Int Orthop, 2011, 35(7): 1037-1042.
  13. 13. 張宏其, 王永福, 唐明星, 等. 牽引結(jié)合后路手術(shù)治療重度脊柱側(cè)凸的療效分析. 中國(guó)矯形外科雜志, 2009, 17(21): 1617-1620.
  14. 14. Suk SI, Kim JH, Cho KJ, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation? Eur Spine J, 2007, 16(9): 1359-1365.
  15. 15. Luhmann SJ, Lenke LG, Kim YJ, et al. Financial analysis of circumferential fusion versus posterior-only with thoracic pedicle screw constructs for main thoracic idiopathic curves between 70 degrees and 100 degrees. J Child Orthop, 2008, 2(2): 105-112.
  16. 16. 賈全章, 孫景海, 侯明曉, 等. 凹側(cè)雙棒全椎弓根螺釘技術(shù)對(duì)提高重度僵硬性特發(fā)性脊柱側(cè)凸矯治效果的作用. 解放軍醫(yī)學(xué)雜志, 2009, 34(6): 683-685.
  17. 17. Modi HN, Suh SW, Hong JY, et al. Accuracy of thoracic pedicle screw using ideal pedicle entry point in severe scoliosis. Clin Orthop Relat Res, 2010, 468(7): 1830-1837.
  18. 18. 王冰, 呂國(guó)華, 陳瑞松, 等. 重度特發(fā)性脊柱側(cè)凸胸椎椎弓根螺釘徒手置入精確性的CT評(píng)價(jià). 中南大學(xué)學(xué)報(bào): 醫(yī)學(xué)版, 2009, 34(3): 226-229.
  19. 19. Wang Y, Zheng G, Zhang X, et al. Comparative analysis between shape memory alloy-based correction and traditional correction technique in pedicle screws constructs for treating severe scoliosis. Eur Spine J, 2010, 19(3): 394-399.
  20. 20. Rosales LM, Miramontes V, Reyes AS. External fixation for dynamic correction of severe scoliosis. Spine J, 2005, 5(4): 418-426.
  21. 21. Bullmann V, Halm HF, Schulte T, et al. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. Eur Spine J, 2006, 15(4): 440-448.
  22. 22. Suk SI, Kim JH, Chung ER, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
  23. 23. Lenke LG, O’leary PT, Bridwell KH, et al. Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine (Phila Pa 1976), 2009, 34(20): 2213-2221.
  24. 24. Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010, 468(3): 687-699.
  25. 25. Hamzaoglu A, Alanay A, Ozturk C, et al. Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine (Phila Pa 1976), 2011, 36(5): E340-E344.
  26. 26. Matsumoto M, Watanabe K, Tsuji T, et al. Progressive kyphoscoliosis associated with tethered cord treated by posterior vertebral column resection: a case report. Spine (Phila Pa 1976), 2009, 34(26): E965-E968.
  27. 27. Smith JS, Wang VY, Ames CP. Vertebral column resection for rigid spinal deformity. Neurosurgery, 2008, 63(3 Suppl): 177-182.
  28. 28. Nepple JJ, Lenke LG. Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy. Spine J, 2009, 9(7): e9-e13.
  29. 29. Xie J, Wang Y, Zhao Z, et al. One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary? Eur spine J, 2011, 20(7): 1106-1113.
  30. 30. 郭海龍, 鄭新峰, 盛偉斌, 等. 后路楔形截骨治療僵硬性脊柱側(cè)彎．中國(guó)修復(fù)重建外科雜志, 2010, 24(7): 885-888．.
  31. 31. 李超, 周宇, 付青松, 等. 經(jīng)后路胸膜外松解脊椎楔形截骨治療重度特發(fā)性脊柱側(cè)凸. 中國(guó)脊柱脊髓雜志, 2009, 19(3): 182-187．.
  32. 32. 李超, 付青松, 周宇, 等. 一期胸腰椎兩處截骨治療重度先天性脊柱側(cè)凸并脊髓拴系綜合征. 中國(guó)脊柱脊髓雜志, 2010, 20(12): 1003-1007.
  33. 33. Bakaloudis G, Lolli F, Di MS, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20(Suppl 1): S95-104.
  34. 34. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of smith-petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2037.
  35. 35. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-S178.
  36. 36. Sucato DJ. Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976), 2010, 35(25): 2186-2192.
  37. 37. Diab MG, Franzone JM, Vitale MG. The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique. J Pediatr Orthop, 2011, 31(1 Suppl): S88-S98.
  38. 38. Suh SW, Modi HN, Yang J, et al. Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis: a preliminary study. Spine (Phila Pa 1976), 2009, 34(12): 1315-1320.
  39. 39. Modi HN, Suh SW, Hong JY, et al. Posterior multilevel vertebral osteotomy for severe and rigid idiopathic and nonidiopathic kyphoscoliosis: a further experience with minimum two-year follow-up. Spine (Phila Pa 1976), 2011, 36(14): 1146-1153.
  40. 40. Wang Y, Mao K, Xiao S, et al. Clinical application of computer-designed polystyrene models in complex severe spinal deformities: a pilot study. Eur Spine J, 2010, 19(5): 797-802.
  41. 41. Wu Z, Huang L, Sang H, et al. Accuracy and safety assessment of pedicle screw placement using the rapid prototyping technique in severe congenital scoliosis, 2010.
  42. 42. Yang JC, Ma XY, Lin J, et al. Personalised modified osteotomy using computer-aided design-rapid prototyping to correct thoracic deformities. Int Orthop, 2011, 35(12): 1827-1832.
  43. 43. Shen J, Qiu G, Wang Y, et al. Comparison of 1-stage versus 2-stage anterior and posterior spinal fusion for severe and rigid idiopathic scoliosis—a randomized prospective study. Spine (Phila Pa 1976), 2006, 31(22): 2525-2528.
  44. 44. Li M, Ni J, Li Y, et al. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in china. J Paediatr Child Health, 2009, 45(5): 246-253.
  45. 45. Sucato DJ, Erken YH, Davis S, et al. Prone thoracoscopic release does not adversely affect pulmonary function when added to a posterior spinal fusion for severe spine deformity. Spine (Phila Pa 1976), 2009, 34(8): 771-778.
  46. 46. Mirzanli C, Ozturk C, Karatoprak O, et al. Double-segment total vertebrectomy for the surgical treatment of congenital kyphoscoliosis: a case report. Spine J, 2008, 8(4): 683-686.
  47. 47. Lonner BS, Murthy SK, Boachie OA. Single-staged double anterior and posterior spinal reconstruction for rigid adult spinal deformity: a report of four cases. Spine J, 2005, 5(1): 104-108.
  48. 48. 張宏其, 魯世金, 陳靜, 等. 廣泛后路松解三維矯形治療重度特發(fā)性脊柱側(cè)凸. 中國(guó)脊柱脊髓雜志, 2007, 17(4): 274-279.
  49. 49. 馬華松, 周建偉, 鄒德威, 等. 重度僵硬型脊柱側(cè)凸的后路非全椎體截骨手術(shù)治療. 中國(guó)矯形外科雜志, 2010, 18(16): 1323-1326．.
  50. 50. 馬華松, 鄒德威, 周建偉, 等. 重度脊柱側(cè)后凸畸形的后路分期手術(shù)治療. 中國(guó)脊柱脊髓雜志, 2009, 19(8): 588-592.