三平一正：极重度脊柱侧弯畸形手术矫形治疗目标

Treatment Goal for Extremely Severe Scoliosis Correction

摘要: 目的：通过病例回顾性分析，探讨极重度脊柱侧弯畸形手术矫正新目标的可行性。方法：回顾分析自2014年6月~2015年2月，本院采用头盆环牵引 + 凹侧胸廓成形+全椎体截骨术 + 凸胸廓成形术+肩胛骨成形术联合治疗极重度脊柱侧弯畸形患者43例。分析其治疗前后外观、肺功能、影像学参数等指标的变化，对治疗效果进行评估。结果：本组病例共43例患者，其中男性20例，女性23例，平均年龄20.5岁。术后患者随访时间达30.5 ± 4.7月。患者术前平均侧弯168.25˚ ± 14.28˚，平均后凸151.38˚ ± 28.60˚，术后则分别为48.25˚ ± 8.29˚ 和30.75˚ ± 13.80˚。肺功能结果显示，所有患者术前均存在重度呼吸功能受损，其中32例为极重度呼吸功能受损，经治疗后肺功能均有不同程度改善，末次随访时肺功能则为轻度呼吸功能受损7例，中度呼吸功能受损16例，重度呼吸功能受损20。术后平均身高增加约22.5 ± 6.1 cm。术后患者外观表现均达到双肩、双髋关节基本等高，背部未见明显凸起，极大的改善患者外观。无神经损害并发症发生，无明显远期并发症的发生。结论：对于极重度脊柱侧弯畸形患者，头盆环牵引 + 凹侧胸廓成形 + 全椎体截骨术 + 凸胸廓成形术 + 肩胛骨成形术联合治疗的策略是安全的，并且患者可以达到“三平一正一改善”的治疗目标，极大的提高了患者治疗满意度以及促进了患者术后恢复正常健康的社会生活。

Abstract: Objective: To evaluate the outcomes of extremely severe scoliosis treated with halo-pelvic traction and the feasibility of the new treatment goal. Methods: 43 patients diagnosis with extremely severe scoliosis underwent a combined treatment including halo-pelvic traction, concave and convex thoracoplasty, vertebral column resection (VCR) and scapula-plasty from Jun 2014 to Feb 2015 were recorded. The parameters of imaging, result of pulmonary function test (PFT) and appearance pre- and post-treatment were analyzed. Results: 20 male and 23 female patients were included. The average age was 20.5 years old. The preoperative mean Cobb’s angle of main curve and kyphosis was 168.25˚ ± 14.28˚ and 151.38˚ ± 28.60˚, and respectively decreased to 48.25˚ ± 8.29˚ and 30.75˚ ± 13.80˚ after treatment. A comparison of patients with pulmonary impairment preoperative vs. follow up found 0 vs. 7 patients had mild impairment, 0 vs. 16 patients had moderate impairment, 11 vs. 20 patients had severe impairment, and 32 vs. 0 had extremely severe impairment. The mean follow up was 30.5 ± 4.7 months. The height increased 22.5 ± 6.1 cm averagely. The scapula and pelvis rebalanced after the treatment. No obvious humpback remained. The appearance improved satisfactorily. No severe complication occurred. Conclusion: The combined treatment strategy for extremely severe scoliosis is safe, and the outcome is satisfactory. The new treatment goal including balance of scapula and pelvis, no obvious humpback, improvement of pulmonary function and normal blood gas could achieve though the strategy. And the clinical outcome may help these patients improve the quality of life.