后路小切口微创分期技术在脊柱侧凸矫形中的临床应用研究
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摘要
目的早发型脊柱侧凸和重度脊柱侧凸一直是脊柱畸形临床治疗的难点。有报道采用“生长阀”治疗早发型脊柱侧凸,多点多棒撑开或脊柱截骨术治疗重度脊柱侧凸,但后路小切口微创分期技术在这两种侧凸中应用报道很少。本研究就是要通过临床观察研究,来评估后路小切口微创分期治疗技术在早发型脊柱侧凸和重度脊柱侧凸矫正中的可行性、疗效和安全性。
方法第一部分：57例早发型小儿脊柱侧凸分别接受生长阀和小切口微创分期手术治疗。按手术术式分为两组：生长阀组和小切口组,对两组病例临床数据和影像学资料进行回顾性对照研究。其中生长阀组18例,男6例,女12例,年龄8.2±1.4岁(5～11岁)。术前侧凸的主侧凸在冠状面cobb's角为平均92.0±16.4°(72～1320)。矢状面后凸cobb's角为平均40.8±15.2°(22～69°)。一期采用后路脊柱凹侧显露置钉,中华长城脊柱内固定系统多米诺“生长阀”系统进行矫形固定,以后每隔6～12个月后再进行一次生长矫形,至患儿到12～14岁骨骼发育成熟后作终末矫形内固定,行剃刀背切除并植骨融合。小切口组39例,男12例,女27例,年龄8.5±1.2岁(6～11岁)。术前侧凸的主侧凸在冠状面cobb's角为平均95.0±15.4°(78～135°)。矢状面后凸cobb's角为平均38.8±14.7°(17～65°)。一期采用小切口微创手术,将脊柱侧凸矫正约50%左右,以后每隔6-12个月后再进行一次生长矫形,同样至患儿到12-14岁骨骼发育成熟后作终末矫形内固定,行剃刀背切除并植骨融合。第二部分：32例行后路小切口微创分期手术治疗的重度脊柱侧凸病例进行回顾性研究。其中男9例,女23例,年龄13-26岁,平均16.8岁。术前侧凸主侧凸95°～175°,平均为129.4°；后路矫形采用分期手术,一期采用小切口内撑开矫形,使侧凸得到部分矫正。3-6个月后再进行后路二期矫形,行后路松解、截骨矫形或者单纯后路矫形,并进行剃刀背切除和植骨融合,随访2～5年,平均3.5年。所有患者术前、一次术后、二次术前、二次术后以及末次随访的的影像学和临床资料以及围手术期并发症的发生情况均进行记录。
结果所有病例均顺利完成手术。第一部分：生长阀组平均随访5年2个月。10例最终完成预期的多次延长并进行终末融合手术,3例在生长调节中发生自发融合直接行终末融合术,5例仍在进一步随访中。13例已融合患儿中1例完成5次调整,3例完成4次调整,7例完成3次调整,2例完成2次调整。共调整42例次,平均调整3.3次/例。发生断棒13例次,内固定松动拔出8例次,皮肤破溃感染3例次。所有病例均无严重神经系统并发症发生。初次手术平均矫正41.1°,矫形率45%。以后第一次延长可获得平均26°的矫正。多次延长平均只能获得18°的矫正。终末融合后侧凸主侧凸冠状面cobb's角为37.2±22.1°(31～64°),平均矫形率59.6%。小切口组共39例,平均随访2年8个月。12例完成终末融合手术,其中4例完成2次延长手术,8例完成1次延长手术后融合；余27例中11例完成2次延长手术,16例完成1次延长手术。所有病例均顺利完成手术,其中随访期间断棒3例,内固定松动2例,皮肤感染1例,术中发现自发性融合2例。无严重并发症发生。完成终末融合手术的初次小切口矫形术后侧凸主侧凸冠状面cobb's角为49.2±10.1°(35～66°),平均矫正50°,矫正率52.9%。以后第一次延长平均获得290的矫正,终末融合时术后侧凸主侧凸冠状面cobb's角为31.8±6.6°(27-48°),总矫形率为65.4%。第二部分：重度脊柱侧凸经小切口分期手术治疗,一次手术矫正58.9°,矫形率45.4%,二次手术矫正30.6°,矫形率24.6%。间隔期矫形丢失率7.1%,总矫形率62.9%,随访2年矫形平均丢失率3.9°,最终总矫形率59.7%.术前后凸30°-170°,平均为80.3°,总矫形42.2°。躯干和双肩的失平衡均得到显著改善。
结论早发型小儿脊柱侧凸的患者采用小切口微创分期延长技术或生长阀技术延缓了脊柱融合的时间,避免了早期融合对脊柱生长发育的影响。小切口微创分期延长技术术治疗较生长阀技术具有更高的矫形率,同时并发症发生率低,是值得推荐的治疗早发型小儿脊柱侧凸有效方法。对重度脊柱侧凸,后路小切口分期手术创伤小,术后恢复快,提高了二次手术耐受力和矫形率。分期手术策略矫形治疗重度脊柱侧凸或后凸畸形效果好,安全性高。
Objective Early onset scoliosis and severe scoliosis are tough challenges to spine surgeons for a long period. Growth valve technique was reported to treat early onset scoliosis and distraction by multiple points and rods technique was also reported to treat severe scoliosis cases. The study is to evaluate the effectiveness and safety of posterior small incision technique in the treatment of early onset scoliosis and severe scoliosis by stages.
Methods For the first part, retrospective control investigation of the clinical data and images of57early onset scoliosis patients who treated in our spinal center was held. The patients were divided into two groups by two different growing techniques. One is growth valve technique group and the other is small-incision technique group. For the growth valve group,18cases (range,5-11years; mean,8.2years; render,6males and12females) were included. The average preoperative major curve angle was92.0±16.4°(68～142°). The average preoperative kyphosis was40.8±15.2°(22～69°).All of them were treated with posterior growth valve technique using China Great Wall spinal instrumentation system after the spine was exposed in the concave side. The spine growing surgery was performed6～12months later. Final fusion surgery and thoracoplasty surgery was performed when the patient was12～14years old and skeletally Initial mature. For the small-incision group,39cases (range,6-12years; mean,8.1years; render,12males and27females) were included. The average preoperative major curve angle was92.0±15.4°(78～135°). The average preoperative kyphosis angle was38.8±14.7°(17～65°). All of them underwent small incision minimally invasive surgery by multiple stages. The first stage posterior surgery was performed by2small incisions and minimally invasive technique. The second stage surgery was performed6～12months later. Final fusion surgery and thoracoplasty surgery was performed when the patient was12-14years old and skeletally Initial mature. For the second study,32patients (range,13-26years; mean,16.8years; gender,9males23 females) with severe scoliosis were treated with posterior operation by two stages. The mean preoperative Cobb angle was129.4°(95°～175°). The posterior surgical procedures were performed by two stages. First stage surgery was performed with posterior small incision and less invasive technique. For the second stage, posterior correction with osteotomy, facet joints release, shave abnormality excision and fusion were performed surgery3-6months later. Pretreatment radiographs and radiographs taken after first surgery (internal distraction by two small incisions), before second surgery (posterior correction, instrumentation and fusion), one week after second surgery and final follow-up were measured. Subjects were analyzed by age, gender, major coronal curve magnitude, flexibility of major curve, major sagittal curve magnitude before first surgery, after first surgery, before second surgery, after second surgery and at final follow-up. Complications related to two-stage surgeries were noted in each case.
Results For the first study, the mean follow time of the growth valve group was5years and2months.10patients finished the final fusion surgery,3cases spontaneous fusion.1case finished5times of growth surgery,3cases finished4times of growth surgery,7cases finished3times of growth surgery, and2cases finished2times of growth surgery.13cases broken rods,8cases screw loose,3cases skin infection. There were none server complications occurred. The curve correction was41.1°and26°were achieved after the first growing surgery. The mean correction was18°after that. The major curve was40.2±22.1°(31～64°) after the final fusion surgery and the mean overall correction rate was59.6%.For the small-incision group, the mean follow up time was2years and8months.12cases finished the final fusion surgery,11cases underwent2times of growth,16cases underwent growth surgery once. During the follow up, rod broken1case, internal fixation loose1case, spontaneous fusion1cases, skin infection1case and no severe complications was found. The major curve after the final fusion surgery was31.8±6.6°(27～48°) and the mean overall correction rate was65.4%. There are significant statistic differences between two groups. For the second study, The average major curve magnitude was129.4°(range,95°to175°), reduced58.9°or45.4%after first stage surgery and reduced30.6°or24.6%after second stage surgery. The lost of correction during the interval between two surgeries was7.1%. The total major coronal curve correction was81.4°or62.9%. Loss of correction averaged3.9°or major coronal curve and the final correction rate was averaged59.7%. The average major sagittal curve magnitude was80.3°(range,30°to170°), and the total major sagittal curve correction was48.2°. Loss of correction averaged4.0°for major sagittal curve and the final correction averaged42.2°.
Conclusions small incision and minimally invasive surgery by stages in the treatment of early onset scoliosis was safe and the correction rate was improved compared with growth valve technique. This technique delayed the final fusion surgery and reduced the impact of early fusion of the spine and decreased surgery related complications in the skeletally immature EOS patients. Two-stage surgery for the treatment of severe scoliosis was a safe and effective surgical strategy in this difficult population. By using two-small-incision technique, the first stage surgery was less invasive and the final correction rate was high. No permanent neurologic deficit was noted in this series.
方法第一部分：57例早发型小儿脊柱侧凸分别接受生长阀和小切口微创分期手术治疗。按手术术式分为两组：生长阀组和小切口组,对两组病例临床数据和影像学资料进行回顾性对照研究。其中生长阀组18例,男6例,女12例,年龄8.2±1.4岁(5～11岁)。术前侧凸的主侧凸在冠状面cobb's角为平均92.0±16.4°(72～1320)。矢状面后凸cobb's角为平均40.8±15.2°(22～69°)。一期采用后路脊柱凹侧显露置钉,中华长城脊柱内固定系统多米诺“生长阀”系统进行矫形固定,以后每隔6～12个月后再进行一次生长矫形,至患儿到12～14岁骨骼发育成熟后作终末矫形内固定,行剃刀背切除并植骨融合。小切口组39例,男12例,女27例,年龄8.5±1.2岁(6～11岁)。术前侧凸的主侧凸在冠状面cobb's角为平均95.0±15.4°(78～135°)。矢状面后凸cobb's角为平均38.8±14.7°(17～65°)。一期采用小切口微创手术,将脊柱侧凸矫正约50%左右,以后每隔6-12个月后再进行一次生长矫形,同样至患儿到12-14岁骨骼发育成熟后作终末矫形内固定,行剃刀背切除并植骨融合。第二部分：32例行后路小切口微创分期手术治疗的重度脊柱侧凸病例进行回顾性研究。其中男9例,女23例,年龄13-26岁,平均16.8岁。术前侧凸主侧凸95°～175°,平均为129.4°；后路矫形采用分期手术,一期采用小切口内撑开矫形,使侧凸得到部分矫正。3-6个月后再进行后路二期矫形,行后路松解、截骨矫形或者单纯后路矫形,并进行剃刀背切除和植骨融合,随访2～5年,平均3.5年。所有患者术前、一次术后、二次术前、二次术后以及末次随访的的影像学和临床资料以及围手术期并发症的发生情况均进行记录。
结果所有病例均顺利完成手术。第一部分：生长阀组平均随访5年2个月。10例最终完成预期的多次延长并进行终末融合手术,3例在生长调节中发生自发融合直接行终末融合术,5例仍在进一步随访中。13例已融合患儿中1例完成5次调整,3例完成4次调整,7例完成3次调整,2例完成2次调整。共调整42例次,平均调整3.3次/例。发生断棒13例次,内固定松动拔出8例次,皮肤破溃感染3例次。所有病例均无严重神经系统并发症发生。初次手术平均矫正41.1°,矫形率45%。以后第一次延长可获得平均26°的矫正。多次延长平均只能获得18°的矫正。终末融合后侧凸主侧凸冠状面cobb's角为37.2±22.1°(31～64°),平均矫形率59.6%。小切口组共39例,平均随访2年8个月。12例完成终末融合手术,其中4例完成2次延长手术,8例完成1次延长手术后融合；余27例中11例完成2次延长手术,16例完成1次延长手术。所有病例均顺利完成手术,其中随访期间断棒3例,内固定松动2例,皮肤感染1例,术中发现自发性融合2例。无严重并发症发生。完成终末融合手术的初次小切口矫形术后侧凸主侧凸冠状面cobb's角为49.2±10.1°(35～66°),平均矫正50°,矫正率52.9%。以后第一次延长平均获得290的矫正,终末融合时术后侧凸主侧凸冠状面cobb's角为31.8±6.6°(27-48°),总矫形率为65.4%。第二部分：重度脊柱侧凸经小切口分期手术治疗,一次手术矫正58.9°,矫形率45.4%,二次手术矫正30.6°,矫形率24.6%。间隔期矫形丢失率7.1%,总矫形率62.9%,随访2年矫形平均丢失率3.9°,最终总矫形率59.7%.术前后凸30°-170°,平均为80.3°,总矫形42.2°。躯干和双肩的失平衡均得到显著改善。
结论早发型小儿脊柱侧凸的患者采用小切口微创分期延长技术或生长阀技术延缓了脊柱融合的时间,避免了早期融合对脊柱生长发育的影响。小切口微创分期延长技术术治疗较生长阀技术具有更高的矫形率,同时并发症发生率低,是值得推荐的治疗早发型小儿脊柱侧凸有效方法。对重度脊柱侧凸,后路小切口分期手术创伤小,术后恢复快,提高了二次手术耐受力和矫形率。分期手术策略矫形治疗重度脊柱侧凸或后凸畸形效果好,安全性高。
Objective Early onset scoliosis and severe scoliosis are tough challenges to spine surgeons for a long period. Growth valve technique was reported to treat early onset scoliosis and distraction by multiple points and rods technique was also reported to treat severe scoliosis cases. The study is to evaluate the effectiveness and safety of posterior small incision technique in the treatment of early onset scoliosis and severe scoliosis by stages.
Methods For the first part, retrospective control investigation of the clinical data and images of57early onset scoliosis patients who treated in our spinal center was held. The patients were divided into two groups by two different growing techniques. One is growth valve technique group and the other is small-incision technique group. For the growth valve group,18cases (range,5-11years; mean,8.2years; render,6males and12females) were included. The average preoperative major curve angle was92.0±16.4°(68～142°). The average preoperative kyphosis was40.8±15.2°(22～69°).All of them were treated with posterior growth valve technique using China Great Wall spinal instrumentation system after the spine was exposed in the concave side. The spine growing surgery was performed6～12months later. Final fusion surgery and thoracoplasty surgery was performed when the patient was12～14years old and skeletally Initial mature. For the small-incision group,39cases (range,6-12years; mean,8.1years; render,12males and27females) were included. The average preoperative major curve angle was92.0±15.4°(78～135°). The average preoperative kyphosis angle was38.8±14.7°(17～65°). All of them underwent small incision minimally invasive surgery by multiple stages. The first stage posterior surgery was performed by2small incisions and minimally invasive technique. The second stage surgery was performed6～12months later. Final fusion surgery and thoracoplasty surgery was performed when the patient was12-14years old and skeletally Initial mature. For the second study,32patients (range,13-26years; mean,16.8years; gender,9males23 females) with severe scoliosis were treated with posterior operation by two stages. The mean preoperative Cobb angle was129.4°(95°～175°). The posterior surgical procedures were performed by two stages. First stage surgery was performed with posterior small incision and less invasive technique. For the second stage, posterior correction with osteotomy, facet joints release, shave abnormality excision and fusion were performed surgery3-6months later. Pretreatment radiographs and radiographs taken after first surgery (internal distraction by two small incisions), before second surgery (posterior correction, instrumentation and fusion), one week after second surgery and final follow-up were measured. Subjects were analyzed by age, gender, major coronal curve magnitude, flexibility of major curve, major sagittal curve magnitude before first surgery, after first surgery, before second surgery, after second surgery and at final follow-up. Complications related to two-stage surgeries were noted in each case.
Results For the first study, the mean follow time of the growth valve group was5years and2months.10patients finished the final fusion surgery,3cases spontaneous fusion.1case finished5times of growth surgery,3cases finished4times of growth surgery,7cases finished3times of growth surgery, and2cases finished2times of growth surgery.13cases broken rods,8cases screw loose,3cases skin infection. There were none server complications occurred. The curve correction was41.1°and26°were achieved after the first growing surgery. The mean correction was18°after that. The major curve was40.2±22.1°(31～64°) after the final fusion surgery and the mean overall correction rate was59.6%.For the small-incision group, the mean follow up time was2years and8months.12cases finished the final fusion surgery,11cases underwent2times of growth,16cases underwent growth surgery once. During the follow up, rod broken1case, internal fixation loose1case, spontaneous fusion1cases, skin infection1case and no severe complications was found. The major curve after the final fusion surgery was31.8±6.6°(27～48°) and the mean overall correction rate was65.4%. There are significant statistic differences between two groups. For the second study, The average major curve magnitude was129.4°(range,95°to175°), reduced58.9°or45.4%after first stage surgery and reduced30.6°or24.6%after second stage surgery. The lost of correction during the interval between two surgeries was7.1%. The total major coronal curve correction was81.4°or62.9%. Loss of correction averaged3.9°or major coronal curve and the final correction rate was averaged59.7%. The average major sagittal curve magnitude was80.3°(range,30°to170°), and the total major sagittal curve correction was48.2°. Loss of correction averaged4.0°for major sagittal curve and the final correction averaged42.2°.
Conclusions small incision and minimally invasive surgery by stages in the treatment of early onset scoliosis was safe and the correction rate was improved compared with growth valve technique. This technique delayed the final fusion surgery and reduced the impact of early fusion of the spine and decreased surgery related complications in the skeletally immature EOS patients. Two-stage surgery for the treatment of severe scoliosis was a safe and effective surgical strategy in this difficult population. By using two-small-incision technique, the first stage surgery was less invasive and the final correction rate was high. No permanent neurologic deficit was noted in this series.
引文
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1.钱邦平,邱勇.严重脊柱侧凸后路矫形术前Halo牵引致臂丛神经麻痹[J].中国脊柱脊髓杂志,2006,16(8)：604-606.
2.邱勇,刘臻,朱锋,等.Halo—股骨髁上牵引对重度脊柱侧凸后路矫形的影响[J].中华外科杂志,2007,45(8)：513-516
3. Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (>100 degrees) [J]. Spine (Phila Pa 1976).2008,33(9):979-83.
4.吴之康,叶启彬,王以鹏.Cobb100°以上脊柱侧凸症的手术矫正[J].中华外科杂志,1988,26(3)：132-134
5.商卫林,侯树勋,史亚民.分期治疗重度僵硬性脊柱侧凸[J].中国脊柱脊髓杂志.1998,8(3)：128-131
6.马华松,邹德威,海涌,等.重度脊柱双侧凸的前后路手术治疗[J].中国矫形外科杂志,2005,13(7)：494-496.
7.海涌,陈志明,马华松,等.重度脊柱侧凸的手术治疗[J].中国脊柱脊髓杂志,2005,15(4)：199-202.
8. QiuY, Liu Z, Zhu F, et, al. Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis:a retrospective study [J]. Orthop Surg, 2007,30(2):22-23.
9.李淳德,李宏,刘宪义,等.后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸[J].北京大学学报(医学版),2007,39(4)：399-402.
10. Buchowski JM, Skaggs DL, Sponseller PD, et al. Temporary internal distraction as an aid to correction of severe scoliosis. Surgical technique [J]. J Bone Joint Surg Am,2007,89 Suppl 2(Pt.2):297-309.
11. NewTon, Powenger DR, Mubarak SL, et al. Anterior release and fusion in pediatric spinal deformity.A comparison of early outcome and cost of thoraco scopic and open thoracothmy approaches.Spine,1997,12:1398-1409
12. Nickel V, Perry J, Garrett A. The halo-a spinal skeletal traction fixation device. J Bone Joint Surg Am 1968,50(7):1400-1409.
13. Mehlman CT, Al-Sayyad MJ, Crawford AH. Effectiveness of Spinal Release and Halo-Femoral Traction in the Management of Severe Spinal Deformity. J Pediatr Orthop.2004,24(6):667-673.
14. Rinella A, Lenke L, Whitaker C, et al. Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine,2005;30(4):475-482
15.邱勇,朱丽华,吕锦瑜,等.90°以上脊柱侧凸的手术策略及方法[J].中华外科杂志,2001,39(2)：102-104
16.李利,史亚民,侯树勋,等.僵硬性脊柱侧凸前、后路松解效果的比较[J].中国脊柱脊髓杂志,2004,14(4)：203-206
17.王以朋,徐宏光,邱贵兴,等.前路松解术在重度青少年特发性脊柱侧凸治疗中的价值[J].中华外科杂志,2004,42(2)：76-80
18. Se-I1 Suk, Jin-Hyok Kim, Kyu-Jung Cho, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation? Eur Spine J,2007,16(9):1359-1365.
19. Smyth RJ, Chapman KR, Wright TA, et al. Pulmonary function in adolescents with mild odiopathic scoliosis. Thorax,1984,39(12): 90-904
20.邱贵兴.李其一.王以朋特发性重度僵硬性脊柱侧凸的手术治疗[J].中华医学杂志,2005,85(12)：807-810
21. Bridwell KH, Lewjs SJ, Lenke LG, el al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance [J]. J Bone Joint Surg Am,2003,85(3):454-463。
22.郭海龙,郑新峰,盛伟斌,等.后路楔形截骨治疗僵硬性脊柱侧弯[J].中国修复重建外科杂志,2010,24(7)：885-888.
23.郑国权,王岩,张永刚,等.扩大“蛋壳”技术治疗100°以上重度特发性脊 柱侧凸畸形[J].脊柱外科杂志,2010,8(2)：71-74.
24. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine 2005,30(14):1682-1687.
25. Seung SW, Modi HN, Yang J, et al. Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis:a preliminary study[J]. Spine.2009,34(12):1315-1320.
26.王岩,张永刚,郑国权,等.脊柱去松质骨截骨治疗僵硬性脊柱侧凸的有效性及安全性分析[J].中华外科杂志,2010,48(22)：1701-1704.
27.邹德威,谭荣.三柱截骨治疗重度僵硬性脊柱侧凸的手术决策与风险规避中华外科杂志2010,48(22)：122-125
28.马华松,周建伟,邹德威,等.重度僵硬型脊柱侧凸的后路非全椎体截骨手术治疗[J].中国矫形外科杂志,2010,18(16)：1323-1326.
1. Branthwaite MA:Cardiores Piratoryeon sequenees of unfused idiopathic scoliosis. Br J Dis Chest 1986:80:360-369.
2. Pehrsson K, LarssonS, odenA, Naehemson A:Long-term follow-up of Patients with untreated scoliosis:A study of mortality, causes of death, and symptoms. Spine 1992:17:1091-1096.
3. James J:Idiopathic scoliosis:The prognosis, diagnosis, and operative indications related to curve Patterns and the age at onset. J Bone Joint Surg Br.1954; 36:36-49.
4. Dickson RA:Early-onset idiopathic scoliosis, in Weinstein S (ed):The Pediatric Spine:Principles and Practice. New York, NY:Raven Press, 1994,421-429.
5. Muirhead A, Conner AN:The assessment of lung function in children with scoliosis. J Bone Joint Surg Br 1985:67:699-702. 1y onset scoliosis.
6. Dubousset J, Herring JA, Shufjlebarger H:The crankshaft phenomenon. J Pediatr Orthop 1989:9:541-550.
7.王亭,邱贵兴。脊柱侧凸后路融合术后的曲轴现象。中华骨科杂志,200525(2)：124-125.
8. Marks DS, Iqbal MJ, Thompson Aq Piggott H:Convex spinal epiphysiodesis in the management of progressive infantile idiopathic scoliosis. Spine 1996; 21:1884-1888.
9. Moe JH, Kharrat K, Winter RB, Cummine JL:Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop 1984; 185:35-45.
10. Marchetti P, Faldini A:"End fusions" in the treatment of some progressive scoliosis in childhood or early adolescence. Orthopaedic Transactions 1978; 2:271.
11. Mineiro J, Weinstein SL:Subcutaneous rodding for progressive spinal curvatures:early results, Journal of Pediatric Orthopaedics,2002, 22:290-295.
12. Blakemore LC, Scoles PV, PoeKochert C, Thompson GH:Submuscular Isola rod with or without limited apical fusion in the management of severe spinal deformities in young children:Preliminary report. Spine 2001:26:2044-204
13. Luque ER, Cardoso A:Treatment of scoliosis without arthrodesis or external support:A preliminary report. Orthopaedic Transactions 1977; 1:37.
14. Mardjetko SM, Hammerberg KW, Lubicky JP, Fister JS:The Luque trolley revisited:Review of nine cases requiring revision. Spine 1992; 17:582-589.
15.邱勇,朱泽章,王斌等。后路可延长型内固定矫正儿童脊柱侧凸的疗效及并发症,中华骨科杂志,2006 26(3)：151-155
16.海涌.对生长棒延长矫正治疗早发性脊柱侧凸的认识.中国脊柱脊髓杂志.2009,19(3)：171-173
17. Akbarnia BA, Marks DS:Instrumentation with limited arthrodesis for the treatment of progressive early-onset scoliosis. Spine:State of the Art Reviews 2000:14:181-189.
18. Akbarnia BA, Marks DS, Boachie-Adjei 0, Thompson A, Asher MA:Dual growing rod technique for the treatment of progressive early onset scoliosis:A multicenter study. Spine 2005; 30:546-557.
19. Thompson GH, Akbarnia BA, Kostial P, et al:Comparison of single and dual growing rod techniques followed through definitive study Spine 2005:30:2039-2044.:A preliminary
20. Campbell RM, Smith MD, Mayes TC, et al:The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 2003; 85:399-408.
21. Campbell RM, Smith MD, Hell-Vocke AK:Expansion thoracoplasty:The surgical technique of openingwedge thoracostomy. Surgical technique. J Bone Joint SurgAm 2004; 86(suppl 1):51-64.
22. Takaso M, Moriya H, Kitahara H, et al:New remote-controlled growing-rod spinal instrumentation possibly applicable for scoliosis in young children. J Orthop Sci 1998; 3:336-340.
1、钱邦平,邱勇.严重脊柱侧凸后路矫形术前Halo牵引致臂丛神经麻痹[J].中国脊柱脊髓杂志,2006,16(8)：604-606.
2、邱勇,刘臻,朱锋等.Halo—股骨髁上牵引对重度脊柱侧凸后路矫形的影响[J].中华外科杂志,2007，45(8)：513-516
3、Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (>100 degrees) [J]. Spine (Phila Pa 1976).2008,33(9):979-83.
4、吴之康,叶启彬,王以鹏.Cobb100°以上脊柱侧凸症的手术矫正[J].中华外科杂志,1988,26(3)：132-134
5、商卫林,侯树勋,史亚民.分期治疗重度僵硬性脊柱侧凸[J].中国脊柱脊髓杂志.1998,8(3)：128-131
6、马华松,邹德威,海涌,等.重度脊柱双侧凸的前后路手术治疗[J].中国矫形外科杂志,2005,13(7)：494-496.
7、海涌,陈志明,马华松,等.重度脊柱侧凸的手术治疗[J].中国脊柱脊髓杂志,2005,15(4)：199-202.
8、QiuY, Liu Z, Zhu F, et, al. Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis:a retrospective study [J]. Orthop Surg, 2007,30(2):22-23.
9、李淳德,李宏,刘宪义,等.后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸[J].北京大学学报(医学版),2007,39(4)：399-402.
10、Buchowski JM, Skaggs DL, Sponseller PD, et al. Temporary internal distraction as an aid to correction of severe scoliosis. Surgical technique[J]. J Bone Joint Surg Am,2007,89 Suppl 2(Pt.2):297-309.
11、海涌,邹德威,马华松,等.特发性脊柱侧凸患者胸椎椎弓根的CT测量及其临床意义[J]中国脊柱脊髓杂志,2003,13(5)：279-282
12、王征,王岩,毛克亚脊柱数字化重建与快速成型对复杂脊柱畸形矫治 的意义[J].中国脊柱脊髓杂志,2006,16(03)：212-216
13、邱贵兴,李其一,王以朋.特发性重度僵硬性脊柱侧凸的手术治疗[J].中华医学杂志,2005,85(12)：807-810
14、Nickel V, Perry J, Garrett A. The halo-a spinal skeletal traction fixation device. J Bone Joint Surg Am 1968,50(7):1400-1409.
15、Mehlman CT, Al-Sayyad MJ, Crawford AH. Effectiveness of Spinal Release and Halo-Femoral Traction, in the Management of Severe Spinal Deformity. J Pediatr Orthop.2004,24(6):667-673.
16、Rinella A, Lenke L, Whitaker C, et al. Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine,2005:30(4):475-482
17、邱勇,朱丽华,吕锦瑜,等.90°以上脊柱侧凸的手术策略及方法[J].中华外科杂志,2001,39(2)：102-104
18、Mehlman CT, Al-Sayyad MJ, Crawford AH, et al. Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity [J]. J Pediatr Orthop.2004,24(6):667-73.
19、李利,史亚民,侯树勋,等.僵硬性脊柱侧凸前、后路松解效果的比较[J].中国脊柱脊髓杂志,2004,14(4)：203-206
20、王以朋,徐宏光,邱贵兴,等.前路松解术在重度青少年特发性脊柱侧凸治疗中的价值[J].中华外科杂志,2004,42(2)：76-80
21、Se-I1 Suk, Jin-Hyok Kim, Kyu-Jung Cho, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation? Eur Spine J 2007,16(9):1359-1365.
22、张宏其,鲁世金,陈静,等.广泛后路松解三维矫形治疗重度特发性脊柱侧凸[J].中国脊柱脊髓杂志,2007,17(4)：274-278.
23、Bridwell KH, Lewjs SJ, Lenke LG, el al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance[J].J Bone Joint Surg Am,2003,85(3):454-463。
24、郭海龙,郑新峰,盛伟斌,等.后路楔形截骨治疗僵硬性脊柱侧弯[J]. 中国修复重建外科杂志,2010,24(7)：885-888.
25、郑国权,王岩,张永刚,等.扩大“蛋壳”技术治疗100°以上重度特发性脊柱侧凸畸形[J].脊柱外科杂志,2010,8(2)：71-74.
26、Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine 2005,30(14):1682-1687.
27、Seung SW, Modi HN, Yang J, et al. Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis:a preliminary study [J]. Spine.2009,34(12):1315-1320.
28、王岩,张永刚,郑国权,等.脊柱去松质骨截骨治疗僵硬性脊柱侧凸的有效性及安全性分析[J].中华外科杂志,2010,48(22)：1701-1704.
29、马华松,邹德威,周建伟,等.重度脊柱侧后凸畸形的后路分期手术治疗[J].中国脊柱脊髓杂志,2009,19(8)：588-589.
30、马华松,周建伟,邹德威,等.重度僵硬型脊柱侧凸的后路非全椎体截骨手术治疗[J].中国矫形外科杂志,2010，18(16)：1323-1326.
31、商卫林,侯树勋,史亚民,等.分期治疗重度僵硬性脊柱侧凸[J].中国脊柱脊髓杂志,1998,8(3)：128-132
32、Buchowski JM, Bhatnagar R, Skaggs DL, et al. Temporary internal distraction as an aid to correction of severe scoliosis[J]. J Bone Joint Surg Am,2006,88(9):2035-41.
33、马华松,周建伟,邹德威,等.极重度脊柱侧凸的二期手术治疗[J].脊柱外科杂志,2007,5(6)：334-337.
34、Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation[J]. Spine,1997, 22(14):1590-1599.
35、邹德威,谭荣.三柱截骨治疗重度僵硬性脊柱侧凸的手术决策与风险规避中华外科杂志2010,48(22)：122-125
36、倪春鸿,侯炯,许华.常压及控制性降压下脊髓急性牵拉损伤比较研究[J].脊柱外科杂志,2004,2(4)：213-215
2. Campbell RM Jr, Smith MD, Mayes TC, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis[J].J Bone Joint Surg Am,2003,85 (4):399-408.
3. Akbarnia BA, Marks DS, Boachie-Adjei FO, et al. Dual growing rod technique for the treatment of progressive early-onset scoliosis [J], Spine,2005,30 (17 Suppl):46-57.
4. Campbell RM Jr, Smith MD, Mangos JA, et al.The treatment of thoracic insufficiency syndrome associated with progressive early onset scoliosis by opening wedge thoracostomy [C].Presented at the Annual Meeting of the Scoliosis Research Society.Miami, FL:2005.
5. Yang JS, McElroy MJ, Akbarnia BA, et al.Growing rods for spinal deformity: characterizing consensus and variation in current use. J Pediatr Orthop.2010 Apr-May;30(3):264-70.
6. Kesling KL, Lonstein JE, Denis F, et al.The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis:a review of 54 patients. Spine (Phila Pa 1976).2003 Feb 1;28(3):267-71.
7. Benli IT, Ates B, Akalin S, et al. Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation. Eur Spine J.2007 Mar;16(3):381-91.
8. Harrington PR.Scoliosis in the growing spine[J].Pediatr Clin North Am,1963,10: 225-245.
9. Marchetti P, Faldini A.'End fusions'in the treatment of some progressive scoliosis in childhood or early adolescence [J]. Orthop Trans,1978,2:271.
10.邱勇,朱泽章,王斌等。后路可延长型内固定矫正儿童脊柱侧凸的疗效及并发症,中华骨科杂志,2006 26(3)：151-155
11. Akbarnia BA, Marks DS:Instrumentation with limited arthrodesis for the treatment of progressive early-onset scoliosis. Spine:State of the Art Reviews 2000;14:181-189.
12. Breakwell LM, Akbarnia BA, Marks DS, et al.End results of dual growing rod techniques followed for 3 to 11 years until final fusion:the effects of frequency of lengthening[C].Presented at the Annual Meeting of the Scoliosis Research Society. Miami, FL:2005.
13. Thompson GH, Akbarnia BA, Kostial P, et al:Comparison of single and dual growing rod techniques followed through definitive study Spine 2005;30:2039-2044.
14.邹德威,海涌,马华松等.脊柱侧凸矫形手术治疗的远期随访结果.中国脊柱脊髓杂志,2003,13(5)：279-282.
15. Takaso M, Moriya H, Kitahara H, et al:New remote-controlled growing-rod spinal instrumentation possibly applicable for scoliosis in young children. J Orthop Sci 1998;3:336-340.
1.钱邦平,邱勇.严重脊柱侧凸后路矫形术前Halo牵引致臂丛神经麻痹[J].中国脊柱脊髓杂志,2006,16(8)：604-606.
2.邱勇,刘臻,朱锋,等.Halo—股骨髁上牵引对重度脊柱侧凸后路矫形的影响[J].中华外科杂志,2007,45(8)：513-516
3. Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (>100 degrees) [J]. Spine (Phila Pa 1976).2008,33(9):979-83.
4.吴之康,叶启彬,王以鹏.Cobb100°以上脊柱侧凸症的手术矫正[J].中华外科杂志,1988,26(3)：132-134
5.商卫林,侯树勋,史亚民.分期治疗重度僵硬性脊柱侧凸[J].中国脊柱脊髓杂志.1998,8(3)：128-131
6.马华松,邹德威,海涌,等.重度脊柱双侧凸的前后路手术治疗[J].中国矫形外科杂志,2005,13(7)：494-496.
7.海涌,陈志明,马华松,等.重度脊柱侧凸的手术治疗[J].中国脊柱脊髓杂志,2005,15(4)：199-202.
8. QiuY, Liu Z, Zhu F, et, al. Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis:a retrospective study [J]. Orthop Surg, 2007,30(2):22-23.
9.李淳德,李宏,刘宪义,等.后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸[J].北京大学学报(医学版),2007,39(4)：399-402.
10. Buchowski JM, Skaggs DL, Sponseller PD, et al. Temporary internal distraction as an aid to correction of severe scoliosis. Surgical technique [J]. J Bone Joint Surg Am,2007,89 Suppl 2(Pt.2):297-309.
11. NewTon, Powenger DR, Mubarak SL, et al. Anterior release and fusion in pediatric spinal deformity.A comparison of early outcome and cost of thoraco scopic and open thoracothmy approaches.Spine,1997,12:1398-1409
12. Nickel V, Perry J, Garrett A. The halo-a spinal skeletal traction fixation device. J Bone Joint Surg Am 1968,50(7):1400-1409.
13. Mehlman CT, Al-Sayyad MJ, Crawford AH. Effectiveness of Spinal Release and Halo-Femoral Traction in the Management of Severe Spinal Deformity. J Pediatr Orthop.2004,24(6):667-673.
14. Rinella A, Lenke L, Whitaker C, et al. Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine,2005;30(4):475-482
15.邱勇,朱丽华,吕锦瑜,等.90°以上脊柱侧凸的手术策略及方法[J].中华外科杂志,2001,39(2)：102-104
16.李利,史亚民,侯树勋,等.僵硬性脊柱侧凸前、后路松解效果的比较[J].中国脊柱脊髓杂志,2004,14(4)：203-206
17.王以朋,徐宏光,邱贵兴,等.前路松解术在重度青少年特发性脊柱侧凸治疗中的价值[J].中华外科杂志,2004,42(2)：76-80
18. Se-I1 Suk, Jin-Hyok Kim, Kyu-Jung Cho, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation? Eur Spine J,2007,16(9):1359-1365.
19. Smyth RJ, Chapman KR, Wright TA, et al. Pulmonary function in adolescents with mild odiopathic scoliosis. Thorax,1984,39(12): 90-904
20.邱贵兴.李其一.王以朋特发性重度僵硬性脊柱侧凸的手术治疗[J].中华医学杂志,2005,85(12)：807-810
21. Bridwell KH, Lewjs SJ, Lenke LG, el al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance [J]. J Bone Joint Surg Am,2003,85(3):454-463。
22.郭海龙,郑新峰,盛伟斌,等.后路楔形截骨治疗僵硬性脊柱侧弯[J].中国修复重建外科杂志,2010,24(7)：885-888.
23.郑国权,王岩,张永刚,等.扩大“蛋壳”技术治疗100°以上重度特发性脊 柱侧凸畸形[J].脊柱外科杂志,2010,8(2)：71-74.
24. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine 2005,30(14):1682-1687.
25. Seung SW, Modi HN, Yang J, et al. Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis:a preliminary study[J]. Spine.2009,34(12):1315-1320.
26.王岩,张永刚,郑国权,等.脊柱去松质骨截骨治疗僵硬性脊柱侧凸的有效性及安全性分析[J].中华外科杂志,2010,48(22)：1701-1704.
27.邹德威,谭荣.三柱截骨治疗重度僵硬性脊柱侧凸的手术决策与风险规避中华外科杂志2010,48(22)：122-125
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