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先天性脊柱侧凸伴高肩胛症的临床评估与手术
前言先天性脊柱侧凸(congenital scoliosis,CS)伴高肩胛症(Congenital elelvation of the scapula,Sprengel'sdeformity)是一种少见而复杂的先天性发育畸形.Tsirikos等[1]分析了537例先天性脊柱畸形患者的肋骨、胸廓及肩胛畸形,在497例CS患者中43例(8.6%)合并高肩胛畸形.Cavendish等[2]报道的100例先天性高肩胛症患者中,有39例(39%)伴CS;与单纯的先天性高肩胛症或CS相比,CS伴高肩胛症的临床评估及手术策略更加复杂,现对这种复杂畸形的临床评估与手术策略作一综述.
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Objective. To evaluate the results of TSRH instrumentation in the correction of coronal, sagittal and rotational deformity of scoliosis. Methods. From January 1998 to December 1999, thirty-two consecutive patients (6 males, 26 females) with scoliosis underwent anterior or posterior spinal instrumentation and fusion using TSRH instrumentation. Of these cases, 21 were idiopathic scoliosis and 11 were congenital scoliosis. The average age at surgery was 16.4 years (range, 11~ 45 years). The mean Cobb angle at surgery was 71 .2 (range, 44 ~ 125 ) in the coronal plane, and 49.2 ( range, 16 ~ 67 ) in the sagittal plane. Rotational deformity (Nash -Moe) ranged from I to III degree. Preoperative apical translation averaged 4.8 cm (range, 3~ 9 cm). Results. The average follow-up duration was 13.3 months (range, 10 ~ 24 months).At the final follow-up, the mean Cobb angle in the coronal plane was 26. 6 (range, 10 ~ 73 ),with a 63.8% of improvement. Sagittal alignment was well maintained with a mean Cobb angle of 28 ( range, 10 ~ 45 ). The average correction of rotation of the apical vertebra was I degree. The average apical translation was 1.6 cm (range, 0.5~ 5.0 cm) representing a correction rate of 66,7% . Complication was noted in two cases with an incidence of 3.1 % , one case had superficial infection and the other one had lower hook dislocation.There was no neurologic deficit and pseudoarthrodesis in this series. Conclusion. TSRH instrumentation is an effective and convenient three-dimensional correction system with a lower rate of complication, which can not only correct the coronal and rotational deformity, but maintain the sagittal alignment as well.
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先天性脊柱侧凸儿童术后康复疗效分析
Obejctive To evaluate the surgical treatment and rehabilitation of the congenital scoliosis.Methods From February 1993 to October 1999,8 cases with congenital scoliosis underwent surgical treatment such as psychological support,limbs movement in bed,early walking,and fixation with orthopedic instrument.Results Mean preoperative and postoperative Cobb's angle was (60.5±8.4) and (30.2± 4.7) degrees respectively.Mean orthopedic rate went up to 50% .Fusion rate of implanted bone was 100% .ADL was (2.8± 0.7) 1 week after operation,(7.3± 1.4) and (15.1± 2.6 3) and 6 months,respectively after operation.(P< 0.05).Conclusion Postoperative rehabilitation treatment for scoliosis is effective.
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先天性脊柱侧弯后路融合术后康复的远期疗效 .
Objective To review our experience on correction of low grade and medium congenital scoliosis by posterior spinal fusion. Method During 1978~ 1998, 56 patients with low grade and medium congenital scoliosis were treated by posterior spinal fusion with autologous bone、 xenogenic bone and recombining xenogenic bone in our department. Preoperative Cobb angles of all patients were less than 40 degrees. Result The study covered 50 patients with minimum follow up period from surgery of 2 years ( mean 9.5 years, ranging from 2~ 22 years ). All patients have got satisfactory fusion, and the Cobb angels of all patients after operation have no increase with the increase of age. Conclusion Posterior spinal fusion in treatment of low grade and medium congenital scoliosis is easy to do, safe and less injury and cost. The follow up results are satisfying. It is necessary and important to use orthosis and doing orthopedic exercise to consolidate and improve the curative effect after operation.
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前方松解、椎体切除加Luque手术治疗小儿先天性脊柱侧弯及后突的体会
本文报告于1986年为改进小儿先天性脊柱侧弯及后突的矫正效果,预防脊髓损伤,作者制定了前方松解、椎体切除和截骨术加Luque手术的方案.经临床17例验证,效果满意.明确并发脊髓纵裂应在矫正侧弯前切除骨间隔.若严格掌握手术指征,小心操作,本手术方案是安全的.
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先天性脊柱侧凸手术治疗的几点体会(附24例术后近期观察)
先天性脊柱侧凸是由单一的、多发的或几乎整个脊柱的先天性异常的椎骨所致~((1)).这种异常椎骨的类型较多,除脊柱裂的发生率高外,以半脊椎畸形为多见,其次为先天性楔形椎,而其它畸形则少见~((2)).先天性脊柱侧凸的治疗是脊柱侧凸治疗中困难的问题~((1)).
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先天性脊柱侧凸手术治疗的几点体会(附24例术后近期观察)
先天性脊柱侧凸是由单一的、多发的或几乎整个脊柱的先天性异常的椎骨所致~((1)).这种异常椎骨的类型较多,除脊柱裂的发生率高外,以半脊椎畸形为多见,其次为先天性楔形椎,而其它畸形则少见~((2)).先天性脊柱侧凸的治疗是脊柱侧凸治疗中困难的问题~((1)).
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Two unusual cases of composite split cord malformations combined with congenital scoliosis