UNIT ROD SEGMENTAL SPINAL INSTRUMENTATION IN THE MANAGEMENT OF PATIENTS WITH PROGRESSIVE NEUROMUSCULAR SPINAL DEFORMITY
UNIT ROD SEGMENTAL SPINAL INSTRUMENTATION IN THE MANAGEMENT OF PATIENTS WITH PROGRESSIVE NEUROMUSCULAR SPINAL DEFORMITY
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DOI：
10.1097/00007632-198912000-00006
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发表时间：
1989-12-01
期刊：
影响因子：
3
通讯作者：
KORESKA, J
中科院分区：
文献类型：
--
作者：
BELL, DF;MOSELEY, CF;KORESKA, J
对34例不能行走的进行性神经肌肉脊椎畸形患者，采用1/4“U形双棒，T2至骨盆节段性内固定，后路脊柱融合术。诊断包括17例脑性瘫痪，6例脊柱裂，11例其他疾病(脊髓性肌萎缩症，弗里德里希‘’S共济失调，多发性神经病，线状肌病和脊髓灰质炎)。23例患者有单曲型无代偿胸腰椎，11例有双曲型。术前大弯平均66°。(范围22-132度)，二次曲线58度。(范围，23-84度)。术后未使用脊柱支撑。平均曲度矫正36度。或54.6%。有四个主要并发症，包括两个植入物失败需要翻修，两个病人在术中失血过多，需要在第二阶段完成手术。有两个神经系统并发症，包括1例术后癫痫发作和1例脊柱裂患者的L4单叶神经病。4名患者术后出现暂时性肠梗阻，1名患者出现胃食道反射，4名患者出现尿路感染。术后无明显肺部并发症发生。剔除棒失效的患者，平均随访21.3个月的矫正损失为6.5%。使用该系统获得的稳定性和曲度矫正支持它在进行性神经肌肉脊柱侧弯患者中继续使用。
Thirty-four nonambulatory patients with progressive neuromuscular spinal deformity were surgically managed using a 1/4" U-shaped double rod construct with segmental instrumentation from T2 to the pelvis accompanied by posterior spinal fusion. Diagnoses included 17 patients with cerebral palsy, six with spina bifida, and 11 with other diseases (spinal muscular atrophy, Friedreich''s ataxia, polyneuropathy, nemaline myopathy, and polio). Twenty-three patients had single uncompensated thoracolumbar curves, and 11 had a double curve pattern. The mean preoperative major curve was 66.degree. (range, 22-132.degree.), the secondary curve 58.degree. (range, 23-84.degree.). No postoperative spinal support was used. Mean curve correction was 36.degree. or 54.6%. There were four major complications, including two implant failures requiring revision and two patients sustaining excessive intraoperative blood loss necessitating completion of the procedure in a second stage. There were two neurologic complications including one case of postoperative seizures and an L4 monoradicular neuropathy in a spina bifida patient. Four patients had temporary postoperative ileus, one gastroesophageal reflex, and four had urinary tract infections. There were no significant postoperative pulmonary complications. Excluding the patients with rod failure, mean loss of correction at mean follow-up of 21.3 months was 6.5%. The stability and curve correction obtained using this system supports its continued use in patients with progressive neuromuscular scoliosis.