MANAGEMENT OF NEUROMUSCULAR SPINAL DEFORMITIES WITH LUQUE SEGMENTAL INSTRUMENTATION
MANAGEMENT OF NEUROMUSCULAR SPINAL DEFORMITIES WITH LUQUE SEGMENTAL INSTRUMENTATION
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DOI：
10.2106/00004623-198971040-00011
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发表时间：
1989-04-01
影响因子：
5.3
通讯作者：
DENIS, F
中科院分区：
文献类型：
--
作者：
BOACHIEADJEI, O;LONSTEIN, JE;DENIS, F
46例神经肌肉脊柱畸形患者接受了关节融合术和Luque节段性脊柱内固定治疗，平均随访3年。22名患者患有脑瘫，24名患者患有另一种神经肌肉疾病。在39例患者中，关节融合术扩展到了骶骨。11例严重脊柱侧弯并伴有骨盆倾斜和躯干失代偿的患者行前后路关节融合术，其余35例均为一期后路手术。术前脊柱侧凸平均为74度，随访时矫正为39度。对于脊柱侧弯，最终的矫正度相似，但对于前后关节融合术患者的骨盆倾斜度和躯干失代偿效果更好。痉挛畸形患者的脊柱侧弯和骨盆倾斜的结果与松弛畸形患者的结果相似。痉挛畸形患者的躯干失代偿矫正效果较好。术后，每组中有一半的患者使用了支具；这似乎不影响两组的矫正量，尽管结果可能受到选择过程的影响。并发症发生率为48%。发生假关节3例(6.5%)。没有重大的神经功能缺陷与矫正或椎板下钢丝的使用有关。3例患者死亡，其中1例死于术后即刻，另2例死于原手术后18个月和4年，死亡原因与手术无关。
Forty-six patients who had a neuromuscular spinal deformity were treated with arthrodesis and Luque segmental spinal instrumentation and were followed for an average of three years. Twenty-two patients had cerebral palsy and twenty-four had another neuromuscular disease. In thirty-nine patients, the arthrodesis was extended to the sacrum. Eleven patients who had severe scoliosis as well as pelvic obliquity and decompensation of the torso had a combined anterior and posterior arthrodesis; the other thirty-five patients had a one-stage posterior procedure. Preoperatively, the average scoliosis was 74 degrees; this was corrected to 39 degrees at follow-up. Final corrections were similar for scoliosis and were better for pelvic obliquity and decompensation of the torso in patients who had combined anterior and posterior arthrodesis. The results for scoliosis and pelvic obliquity in patients who had a spastic deformity were similar to the results in patients who had a flaccid deformity. Correction of decompensation of the torso was better in patients who had a spastic deformity. Postoperatively, a brace was used in half of the patients in each group; this did not appear to affect the amount of correction in either group, although the result may have been influenced by the selection process. The rate of complications was 48 per cent. Pseudarthrosis occurred in three patients (6.5 per cent). There were no major neurological deficits related to the correction or to the use of sublaminar wires. Three patients died, one in the immediate postoperative period and the other two at eighteen months and four years after the original procedure, due to causes unrelated to the operation.