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[目的]比较Lenke 5C青少年特发性脊柱侧凸(AIS)采用VCM技术(vertebral column manipulator)和旋棒技术(RD,rod derotation)矫正的临床效果。[方法]回顾性分析本院脊柱侧弯中心2008年7月~2012年8月收治的36例Lenke 5C AIS患者,按去旋转矫正技术不同分为2组:VCM组26例,RD组15例,所有患者皆具有完整临床和影像资料。研究测量记录患者的10项影像参数,包括主弯顶椎旋转角及其矫正率,主弯Cobb角及其矫正率,主弯顶椎偏移(AVT),C7铅垂线偏移骶骨中央垂线距离(C7-CSVL),C7铅垂线偏移骶骨后上角距离(C7-SSVL),下融合椎倾斜角(LIV-tilt)及其矫正率,下融合椎距稳定椎节段数(LIV-SV),并利用统计学独立样本t检验对两组病例术前、术后的影像参数进行比较。[结果]两组患者皆成功获得手术矫正,术中、术后无严重并发症发生。VCM组和RD组的顶椎旋转角旋转矫正率平均为52.2%和34.4%,两组术前顶椎旋转角无统计学差异(P>0.05),术后顶椎旋转角及旋转矫正率具有明显统计学差异(P<0.05);两组的主弯Cobb角矫正率平均为87.3%和82.4%,两组间无统计学差异(P>0.05);两组的LIV-SV具有明显统计学差异(P<0.05),VCM组明显大于RD组,其均值分别为(1.1±0.3)节和(0.8±0.4)节;两组的LIV-tilt角矫正率平均为77.2%和66.6%,组间无明显统计学差异(P>0.05);两组患者术前、术后的冠状面和矢状面平衡皆得到良好维持。[结论]Lenke 5C AIS采用VCM技术和旋棒技术矫形皆可获得良好的主弯和下融合椎倾斜角矫正及冠状面和矢状面平衡,但VCM技术术后即刻的顶椎旋转矫正和减少腰椎远端融合节段的趋势优于旋棒技术。
[Objective] To compare the clinical effects of treatment of Lenke 5C adolescent idiopathic scoliosis (AIS) with VCM (vertebral column manipulator) and rotation rod technique (RD). [Methods] Thirty-six patients with Lenke 5C AIS admitted to our hospital from July 2008 to August 2012 were retrospectively analyzed. They were divided into two groups according to the rotation correction technique: 26 in the VCM group and 15 in the RD group , All patients have a complete clinical and imaging information. The study measured and recorded 10 imaging parameters of the patients, including the rotation angle of the apex vertebra and its correction rate, the main curve Cobb angle and its correction rate, the main bending apex offset (AVT), C7 plumb line offset the sacral center Line distance (C7-CSVL), C7 plumb line (C7-SSVL), LIV-tilt and its correction rate, and the number of intervertebral stable intervertebral segments (LIV -SV), and using statistical independent sample t test to compare the preoperative and postoperative imaging parameters of two groups of patients. [Results] The two groups of patients were successfully obtained surgical correction, intraoperative and postoperative no serious complications. In the VCM group and RD group, the average rotation rates of apex rotation were 52.2% and 34.4% respectively. There was no significant difference in the rotation angle of the apical vertebra between the two groups (P> 0.05) (P <0.05). The correction rates of Cobb’s angle of the main curve were 87.3% and 82.4% on average in both groups (P> 0.05). The LIV-SV of the two groups had statistically significant (P <0.05). The VCM group was significantly larger than the RD group (1.1 ± 0.3) and (0.8 ± 0.4) sections respectively. The average correction rates of LIV-tilt angle in both groups were 77.2% and 66.6% There was no significant difference between the two groups (P> 0.05). The preoperative and postoperative coronal and sagittal balances were well maintained. [Conclusions] Lenke 5C AIS can achieve good correction of both main and inferior fusion vertebral angle and coronal and sagittal balance with both VCM and rotary rod technique, but the correction and reduction of the apex immediately after VCM technique The trend of distal lumbar fusion segments was superior to that of spinodal.