后路椎弓根螺钉系统治疗特发性脊柱侧凸的临床疗效研究
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摘要
研究背景脊柱侧凸是指脊柱的一个或数个节段向侧方弯曲伴有椎体旋转的三维脊柱畸形。国际脊柱侧凸研究学会(Scoliosis Research Society, SRS)对脊柱侧凸定义：应用Cobb法测量站立正位X线的脊柱侧向偏离曲度达到10°以上的畸形,常见于青少年儿童,严重影响患者的身心健康。脊柱侧弯多在青春期发病,低龄甚至新生儿患脊柱侧弯的比例正在不断攀升,而他们较青少年和成人有更大风险：发展到七八岁时即会严重阻碍呼吸、影响心肺功能发育,从而引发死亡。低龄儿童脊柱侧弯必须尽早手术,否则可能失去手术机会。其中青少年特发性脊柱侧凸最为常见,目前发病机制尚不明确。随着脊柱椎弓根螺钉内固定系统的不断改进,以及三维矫形技术理论的广泛应用,脊柱侧凸畸形得到了有效的治疗。其中,部分患者术后出现了失代偿现象,这使人们意识到需要一种全面有效的分型系统用以指导手术。King分型及其他分型系统的相继出现,有效地指导了脊柱侧凸矫形手术治疗。各种分型有其各自的应用特点,亦有相互联系之处。如何应用分型区分畸形的特点,如何选择正确的融合节段,是脊柱侧凸矫形手术的关键。
研究目的
1.系统回顾脊柱侧凸后路矫形内固定手术治疗特发性脊柱侧凸的临床效果。
2.探讨King分型系统在脊柱侧凸后路椎弓根内固定矫形术的应用价值并且比较此种分型在矫形术中所起到的指导意义。
3.正确的选择性的融合胸椎矫正侧凸患者的临床效果,研究分析跨阶段融合椎体对术后躯干的影响。
4.深入地了解及应用国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)进行患者健康相关的生活质量评价及分析。
研究方法
1.采集自2005年9月份-2009年12月份曾经在我院行脊柱侧凸后路椎弓根镙钉内固定矫治青少年特发性脊柱畸形患者30例,男性11例,女性19例,年龄11岁-23岁,平均年龄14.2岁。病史1-5年,30例均属特发性脊柱侧凸。按照King分型分为,King I型7例,Ⅱ型10例,Ⅲ型8例,Ⅳ型3例,Ⅴ型2例。术前脊柱冠状面畸形Cobb角为45°-72°,平均58.1°,。术后随访6-28个月,平均16.4个月。根据侧弯患者术前及术后随访时X线光片,对站立位冠状面的Cobb角进行测量,讨论整体治疗效果。
2.根据所有患者病例应用King分型系统进行分型,脊柱侧凸患者采用后路椎弓根螺钉内固定系统进行矫形融合手术。根据King分型的指导原则对患者进行手术矫形,根据手术后结果及随访结果将30份病例进行分析,评价各组术后失代偿的情况,分析King分型对手术的指导意义。
3.根据国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)对本次研究中的23位患者进行术前及术后生活质量评分。
研究结果
1.术后所有病例经随访6-28个月,平均16.4个月。术前冠状面Cobb角平均58.1°,术后平均21.3°,平均矫正率为63.0%；顶椎移位距离术前平均2.7cm,术后平均1.1cm,平均矫形率为59.0%;旋转畸形(Nash-Moe法)术前为I-III度,术后平均矫形I度。身高比术前平均增加7cm。所有患者术中、术后均无脊髓神经损伤,未发生任何松钉、断棒现象,植骨愈合率高,达到了脊柱的整体平衡。术后1年均获得满意的脊柱愈合,并保留一定的脊柱活动度,无曲轴现象及附加现象,无其它并发症。随访矫正度丢失4.5°
2.整体治疗情况：术前共计30例存在冠状面躯干失平衡,术后终末随访时仍有7例(25%)。
3.采用国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)术前及术后生活质量评分,发现通过进行后路矫形手术的患者从心理性、功能性及生活质量有较大的改善。
4.主胸弯矫正结果：30例患者术前胸弯Cobb角平均58.1°,术后21.3°,矫正率63.0%；术前代偿腰弯Cobb角平均36.1°,术后17.5°,矫正率53.6%。
研究结论
1.脊柱后路椎弓根镙钉内固定系统进行脊柱侧凸的矫形,可以取得良好的治疗效果。
2.特发性脊柱侧凸King分型系统能有效地指导矫形手术治疗；正确分型的基础上,选择正确椎体的融合范围进行适度的矫正,对手术成功起到比较重要的作用。
3.了解及应用了国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)可以帮助我们比较了解患者自身对术前与术后生活质量的自我评价。
4.有效的植骨融合对术后尽快回复取得了良好的效果,并防止假关节发生,同时给予坚强的内固定。以增加其成骨能力,促进植骨愈合。
Background
Scoliosis refers to the spine of one or several section to lateral bending with vertebral rotating 3d spinal deformity. International Scoliosis Research institute (SRS), Scoliosis true science of Scoliosis measuring Cobb:definition method of X line of positive stand to lateral deviation curvature spinal deformity of 10°above, especially in patients with severe influence of teenagers, the physical and mental health. Scoliosis in adolescence, young even babies had scoliosis ratio is rising. But they are more teenagers and adults have greater risk:the development of eight to which will seriously impede breathing, influence cardiorespiratory function. Thus cause death. Young children scoliosis surgery, or an operation opportunities may be lost. Adolescent idiopathic scoliosis among the most common, pathogenesis unclear. With spinal pedicle screw internal fixation system, and the continuous improvement of 3d orthopaedic technology theory widely, scoliosis deformity effectively. Among them, some patients postoperative appeared decompensated phenomenon, it makes people aware of the need to a comprehensive and effective classification system for guidance. And that of other type system, effective guidance by the scoliosis orthopaedic surgery [10]. Various type has its unique characteristics, has also interconnected. How to distinguish the malformation type application characteristics, how to choose the correct fusion segments, scoliosis orthopaedic surgery.
Research purposes
1 system review scoliosis posterior fixation wires idiopathic scoliosis surgery clinical effects.
2 that type system discussed in scoliosis posterior pedicle fixation wires and comparison of applied value in this type of orthodontic intraoperative significance.
3 the correct selective fusion of patients with thoracic spinal corrective side protruding, research and analysis of clinical effect of vertebral fusion across the stage after the trunk.
4 understanding and application of international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) were associated with health assessment and analysis of the quality of life.
Research methods
1 since September 2005 collected in December 2009-once in our line scoliosis posterior pedicle fixation nail orthod adolescent idiopathic spinal deformity,30 cases of 11 cases, women, men aged 19 cases,11-23 years, average age 14.2years old.1-5 years history,30 cases of idiopathic scoliosis. According to that type, type that I divided into 7 cases,10 cases II type, type III IV 8 cases,3 cases, V type 2 cases. Preoperative spinal deformity coronal Cobb Angle of 45°- 72°, on average,58.1°. Patients were followed up 6-28 months, average 1.64 months. According to the lateral bending the preoperative and postoperative follow-up, patients when light of X line and the standing coronary Cobb, overall Angle measurement outcomes.
2 all cases that according to the application of system type, scoliosis patients using internal fixation of posterior pedicle screws orthopedic fusion surgery system. According to the guiding principle of the type that points to surgery patients, according to results of orthopaedic surgery and follow-up results will be 30 cases of analysis and evaluation of postoperative decompensated groups, analyzes on the operation that points.
3 according to international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) for the Research of the 23 patients before and after the quality of life score.
Research results
1 after all the cases were followed up 6-28 months, average 1.64 months. Preoperative coronal Cobb 58.1°Angle of average, on average, average 21.3°after corrective rate for 63.0%, Top vertebral shift from preoperative average 2.7 cm, average 1.1 cm, after an average rate of 78.9% kyphosis, Rotating malformation (Nash-Moe law) for theⅠ-Ⅲpreoperative and postoperative average orthopaedic I degree. Average height than preoperative 7cm. All patients and no spinal cord injuries, did not happen any loose nails, broken rod phenomenon, bone healing rate is high, reached the overall balance of spine. After a satisfactory with spinal healing, and keep the spinal motion, no certain crankshaft phenomenon and additional phenomenon, no other complications. Follow-up correction degrees lost 4.5 degrees.
2 overall treatment:preoperative total 30 cases of existing coronal trunk lost balance and postoperative follow-up still seven terminal (25%).
3 adopt international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) preoperative and postoperative quality of life score, found the posterior orthopaedic surgery patients from the heart, functional and quality of life for rational has been greatly improved.
4 the chest curved correction result:30 patients with thoracic Cobb bending Angle of preoperative and postoperative average 58.1°, correct rate 63.0%21.3°, Preoperative compensatory Cobb bent on average range, after°Angle, correct rate 53.6% 17.5°
research conclusion
1 posterior spinal pedicle fixation system nail scoliosis wires to achieve good results.
2 idiopathic scoliosis that type system can effectively guide orthopaedic surgery treatment, On the basis of correct classification, choosing the correct vertebral fusion range of surgical correction, moderately successful play more important role.
3 the international understanding and application of Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) may help us better understand oneself of preoperative and postoperative patients with self evaluation and quality of life.
4 the effective integration of bone graft as soon as possible after achieved good results, and to prevent false joints, and given the strong fixation. In order to increase their ability to promote bone healing, bone graft
研究目的
1.系统回顾脊柱侧凸后路矫形内固定手术治疗特发性脊柱侧凸的临床效果。
2.探讨King分型系统在脊柱侧凸后路椎弓根内固定矫形术的应用价值并且比较此种分型在矫形术中所起到的指导意义。
3.正确的选择性的融合胸椎矫正侧凸患者的临床效果,研究分析跨阶段融合椎体对术后躯干的影响。
4.深入地了解及应用国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)进行患者健康相关的生活质量评价及分析。
研究方法
1.采集自2005年9月份-2009年12月份曾经在我院行脊柱侧凸后路椎弓根镙钉内固定矫治青少年特发性脊柱畸形患者30例,男性11例,女性19例,年龄11岁-23岁,平均年龄14.2岁。病史1-5年,30例均属特发性脊柱侧凸。按照King分型分为,King I型7例,Ⅱ型10例,Ⅲ型8例,Ⅳ型3例,Ⅴ型2例。术前脊柱冠状面畸形Cobb角为45°-72°,平均58.1°,。术后随访6-28个月,平均16.4个月。根据侧弯患者术前及术后随访时X线光片,对站立位冠状面的Cobb角进行测量,讨论整体治疗效果。
2.根据所有患者病例应用King分型系统进行分型,脊柱侧凸患者采用后路椎弓根螺钉内固定系统进行矫形融合手术。根据King分型的指导原则对患者进行手术矫形,根据手术后结果及随访结果将30份病例进行分析,评价各组术后失代偿的情况,分析King分型对手术的指导意义。
3.根据国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)对本次研究中的23位患者进行术前及术后生活质量评分。
研究结果
1.术后所有病例经随访6-28个月,平均16.4个月。术前冠状面Cobb角平均58.1°,术后平均21.3°,平均矫正率为63.0%；顶椎移位距离术前平均2.7cm,术后平均1.1cm,平均矫形率为59.0%;旋转畸形(Nash-Moe法)术前为I-III度,术后平均矫形I度。身高比术前平均增加7cm。所有患者术中、术后均无脊髓神经损伤,未发生任何松钉、断棒现象,植骨愈合率高,达到了脊柱的整体平衡。术后1年均获得满意的脊柱愈合,并保留一定的脊柱活动度,无曲轴现象及附加现象,无其它并发症。随访矫正度丢失4.5°
2.整体治疗情况：术前共计30例存在冠状面躯干失平衡,术后终末随访时仍有7例(25%)。
3.采用国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)术前及术后生活质量评分,发现通过进行后路矫形手术的患者从心理性、功能性及生活质量有较大的改善。
4.主胸弯矫正结果：30例患者术前胸弯Cobb角平均58.1°,术后21.3°,矫正率63.0%；术前代偿腰弯Cobb角平均36.1°,术后17.5°,矫正率53.6%。
研究结论
1.脊柱后路椎弓根镙钉内固定系统进行脊柱侧凸的矫形,可以取得良好的治疗效果。
2.特发性脊柱侧凸King分型系统能有效地指导矫形手术治疗；正确分型的基础上,选择正确椎体的融合范围进行适度的矫正,对手术成功起到比较重要的作用。
3.了解及应用了国际脊柱侧凸社会生活质量调查表(Scoliosis Research Society-22, SRS-22)可以帮助我们比较了解患者自身对术前与术后生活质量的自我评价。
4.有效的植骨融合对术后尽快回复取得了良好的效果,并防止假关节发生,同时给予坚强的内固定。以增加其成骨能力,促进植骨愈合。
Background
Scoliosis refers to the spine of one or several section to lateral bending with vertebral rotating 3d spinal deformity. International Scoliosis Research institute (SRS), Scoliosis true science of Scoliosis measuring Cobb:definition method of X line of positive stand to lateral deviation curvature spinal deformity of 10°above, especially in patients with severe influence of teenagers, the physical and mental health. Scoliosis in adolescence, young even babies had scoliosis ratio is rising. But they are more teenagers and adults have greater risk:the development of eight to which will seriously impede breathing, influence cardiorespiratory function. Thus cause death. Young children scoliosis surgery, or an operation opportunities may be lost. Adolescent idiopathic scoliosis among the most common, pathogenesis unclear. With spinal pedicle screw internal fixation system, and the continuous improvement of 3d orthopaedic technology theory widely, scoliosis deformity effectively. Among them, some patients postoperative appeared decompensated phenomenon, it makes people aware of the need to a comprehensive and effective classification system for guidance. And that of other type system, effective guidance by the scoliosis orthopaedic surgery [10]. Various type has its unique characteristics, has also interconnected. How to distinguish the malformation type application characteristics, how to choose the correct fusion segments, scoliosis orthopaedic surgery.
Research purposes
1 system review scoliosis posterior fixation wires idiopathic scoliosis surgery clinical effects.
2 that type system discussed in scoliosis posterior pedicle fixation wires and comparison of applied value in this type of orthodontic intraoperative significance.
3 the correct selective fusion of patients with thoracic spinal corrective side protruding, research and analysis of clinical effect of vertebral fusion across the stage after the trunk.
4 understanding and application of international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) were associated with health assessment and analysis of the quality of life.
Research methods
1 since September 2005 collected in December 2009-once in our line scoliosis posterior pedicle fixation nail orthod adolescent idiopathic spinal deformity,30 cases of 11 cases, women, men aged 19 cases,11-23 years, average age 14.2years old.1-5 years history,30 cases of idiopathic scoliosis. According to that type, type that I divided into 7 cases,10 cases II type, type III IV 8 cases,3 cases, V type 2 cases. Preoperative spinal deformity coronal Cobb Angle of 45°- 72°, on average,58.1°. Patients were followed up 6-28 months, average 1.64 months. According to the lateral bending the preoperative and postoperative follow-up, patients when light of X line and the standing coronary Cobb, overall Angle measurement outcomes.
2 all cases that according to the application of system type, scoliosis patients using internal fixation of posterior pedicle screws orthopedic fusion surgery system. According to the guiding principle of the type that points to surgery patients, according to results of orthopaedic surgery and follow-up results will be 30 cases of analysis and evaluation of postoperative decompensated groups, analyzes on the operation that points.
3 according to international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) for the Research of the 23 patients before and after the quality of life score.
Research results
1 after all the cases were followed up 6-28 months, average 1.64 months. Preoperative coronal Cobb 58.1°Angle of average, on average, average 21.3°after corrective rate for 63.0%, Top vertebral shift from preoperative average 2.7 cm, average 1.1 cm, after an average rate of 78.9% kyphosis, Rotating malformation (Nash-Moe law) for theⅠ-Ⅲpreoperative and postoperative average orthopaedic I degree. Average height than preoperative 7cm. All patients and no spinal cord injuries, did not happen any loose nails, broken rod phenomenon, bone healing rate is high, reached the overall balance of spine. After a satisfactory with spinal healing, and keep the spinal motion, no certain crankshaft phenomenon and additional phenomenon, no other complications. Follow-up correction degrees lost 4.5 degrees.
2 overall treatment:preoperative total 30 cases of existing coronal trunk lost balance and postoperative follow-up still seven terminal (25%).
3 adopt international Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) preoperative and postoperative quality of life score, found the posterior orthopaedic surgery patients from the heart, functional and quality of life for rational has been greatly improved.
4 the chest curved correction result:30 patients with thoracic Cobb bending Angle of preoperative and postoperative average 58.1°, correct rate 63.0%21.3°, Preoperative compensatory Cobb bent on average range, after°Angle, correct rate 53.6% 17.5°
research conclusion
1 posterior spinal pedicle fixation system nail scoliosis wires to achieve good results.
2 idiopathic scoliosis that type system can effectively guide orthopaedic surgery treatment, On the basis of correct classification, choosing the correct vertebral fusion range of surgical correction, moderately successful play more important role.
3 the international understanding and application of Scoliosis social quality of life questionnaire (Scoliosis true science-22, SRS-22) may help us better understand oneself of preoperative and postoperative patients with self evaluation and quality of life.
4 the effective integration of bone graft as soon as possible after achieved good results, and to prevent false joints, and given the strong fixation. In order to increase their ability to promote bone healing, bone graft
引文
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24 Arlet v. Anterior thoracoscopic spine release in deformity surgery:a eta. analysis and review. Eur Spine.2000; 9 Suppl 1:S17-23.
25 Kuklo TR, Lenke LG O'Bden M F, et al. Accuracy and efficacy ofthoracic pedicle screws jn curves more than 90 degrees. Spine.2005:30(2):222-226.
26 Polly D P'PotIer BK. Kuklo Tet al. Volumetric spinal canalintrusion:a comparison between thoracic pedicle screws andthoracic hooks. Spine.2004; 29(11:63-69
27 Kim YJ, Lenke LG, BridwelIKH, et al. Free hand pedicle screw placement in the thoracic spine:is jt safe.Spine.2004; 29(3):333,342.
28 Suk SI, Kim WJ。 Lee SM, et al. Thoracic pedicle screw fixation inspinal deformities:are they really safe.Spine.2001; 26(18):2049-2057.
29 Lonner BS. Ausrbach JD, Estreicher M, et al. Video-assistedthoracoscopic spinal fusion compared with posterior spinal fusion with thoracic pedicle screws for thoracic adolescent idiopathic scoliosis. [J] Bone Joint Surg Am.2009; 91(2): 398-408.
30 Reddi v'Clarke DV Jr,Arlet V Anterior thoracoscopic instrumentation in adolescent idiopathic scoliosis:a systematic review. Spine,2008; 33(18): 1986-1994.
31 Sheron YA. Scoliosis and kyphosis in adolescents:diagnosis and management. Adolesc Med State Art Rev.2007; 18(11:121-139.
32 Smith JR, Sciubba DM, Samdani AF Scoliosis:a straightforward approach to diagnosis and management. JAAPA.2008; 21(11):40-45.
33 Lenke LG Richards S, Stanitski CL. Debate:Resolved, a 55 degree right thoracic adolescent idiopathic scoliotic curve should be treated by posterior spinal fusion and segmental instrumentation using thoracic pedicle screws. [J] Pediatr Orthop.2004; 24:329-341.
34 Han IH。 Chin DK, Kim KS, Short segment antedor correction of adolescent jdiopathic scoliosis. [J] Koraan Neurosurg Soc.2008; 44(1):52-56.
35 Steinmetz M P. Rajpal S, Trost GSegmental spinal instrumentation in the management of scoliosis. Neurosurgery.2008; 63(3 Suppl):131-138.
36 Borgeat A, BlumenthaI S, Postoperative pain management following scoliosis surgery. Curr Opin Anaesthesiol.2008; 21(3):313-316.
37 Yang JS. Sponseller PD. Yazici M, et al. Vascular complications from anterior spine surgery in three patients with Ehlers-Danlos syndrome. Spine.2009; 34(4):E153-157.
38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．中国脊柱脊髓杂志，2003，13：279-282
39史亚民，侯树勋，李利，等．胸椎椎弓根螺钉固定治疗青少年脊柱侧凸．中国脊柱脊髓杂志，2000，lo：200-202
40 Sink EL Karol LA, Sanders J. et al. Efficacy of perioperutive halo-gravity traction in the treatment of severe scoliosis in children. [J] Pediatr Orthop.2001.21:'519-524.
41 Loaner Bs, Murtloy SK. Boachie-Adjei O. Single-staged double anterior and posterior spinal reconstruction for rigid adult spinal deformity:a report of fonr caeses. [J] Spine.2005.5:104-109.
42 Luhmann S, Leanke L. Kim Yiotal. Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees:is anterior re-lease necessary. Spine.2005,15:2061-2067.
43 Arlet V, Jiang L. Ouellet J. Is there a need for anterior release for 70-90 degrees masculine thoracic curves in adolescent scoliosis Euro. [J] Spine.2004.13: 740-745.
44 Burton DC, Sama AA. Asher MA. et al. The treatment of large(>70 degrees)thoracic idiopathic scoliosis curves with posterior imstrume、 ntation and arthrodesis:whwn is anterior release indicated.Spine.2005.30:1979-1984.
45 Hempting A, Ferraris L. Koller H。 et al. Is anterior release effective to increase flexibility in idiopathic thoracic scoliosis,Assessment by traction films. Euro Spine,2007.16:515-520.
46刘洋,李明.重度脊柱侧凸矫形的研究进展.中国脊柱脊髓杂志，2005.15：247-249.
47 Shinichiro Kubo. Naoya Tajima, Etsuo Chosa。 et al. Posterior releasing techigues for idiopathic scoliosis microscpic discectomy and transverse process resection:a technical note. [J] Spinal Disord Tech,2003,16:528.533.
48张宏其.鲁世金,陈静,等.广泛后路松解三维矫形治疗特发性脊柱侧凸.中国脊柱脊髓杂志.2007。17：274-279.
49 Kim YJ, Lenke LG。 Kim J. et al. Comparative analysis of pedicle screw versus hybrid in strumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine.2006,31:291-298.
50 Lenke LG, Kim YI, Rinella AS. Treatment of spinal deformity utilizing thoracic pedicle scrent. Semin Spine Sury,2002,14:66-87.
51 Suk St, Kim WJ. Lee SM, et al. Thoracic pedicle screw fixation inspinal deformites:are they really safe.Spine,2001.26:2049-2057.
52 Kim YJ, Lenke LG. Bridwell KH. et al. Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. [J] Bone Joint Sury Am.2005.87:1534-1541.
53 Hedepuist D, Yeon H, Emon J. The use of allograft as a bone graft substitute in patients with congenital spine deformities[J]. Pediatr Orthop,2007.27:686-689.
54翁爿生,邱贵兴,李军伟,等.同种并体骨与自体骨移植治疗脊柱侧凸的前瞻性研究[J].中华骨科杂志,2004,24：577-580.
55 Newton PO, White KK, Faro F, et al. The saecegs of thomcoscopie anterior fusion in a consecutive series of 112 podiatric spinal deformity cases [J]. Spine, 2005.30:392-398.
56 Kim CW。 Abrams K, Lee G, el al. Use of vascularized fibular graftsas a salvage procedure for prexiotmly failed spinal arthrodesis[J]. Spine,2001.26: 2171-2175.
57 Violas P, Chapuis M。 Braeq}L Local autograft bone in the surgical management of adolescent scoliosis[J]. Spine,2004,29:189-192.
58 Betz RR, Petrizzo AM. Kemer PJ, et al. Allosmft versus no graft with a posterior muhiscgmented hook system for the treatment of idiopathic scoliosis[J]. Spine. 2006,31:121-127.
59 Thompson JP, Transfeldt EE, Bradford DS, et al. Decompensationafter Cotrel-Dubousset instrumentation of idiopathic scoliosis. Spine,1990,15:927-931.
60 Bridwell KH, McAllister JW, Betz RR, et al. Coronal decompensation produced by Cotrel-Dubousset "derotation"maneuver for idiopathic right thoracic scoliosis. Spine,1991,16:769-777.
61 Asher M,Min Lai S, Burton D,et al.The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis [J]. Spine,2003,28(1):63-69.
62 Monticone M, Carabalona R, Negrini S. Reliability of the Scoliosis Research Society-22 Patient Questionnaire (Italian version) in mild adolescent vertebral deformities [J]. Eura Medic-ophys,2004,40(3):191-197.
63 Bago J, Climent JM, Ey A, et al. The Spanish version of the SRS-22 patient questionnaire for idiopathic scoliosis:transcultural adaptation and reliability analysis[J]. Spine,2004,29(15):1676-1680.
64 Alanay A, Cil A, Berk H, et al. Reliability and validity of adapted Turkish Version of Scolio-sis Research Society-22 (SRS-22) questionnaire [J]. Spine, 2005,30(21):2464-2468.
65赵黎.张勇.尚磊等,中文版SRS-22问卷在中国青少年特发性脊柱侧凸患者评价中的应用[J].中华矫形外科杂志，2008,7：1072-1073.
1 张永刚,王继芳,卢世壁等,现代骨库的标准和规章制度.中华骨科杂志，2000,20期刊：87-88
2 Thoren K,Aspenberg P.Ethylene oxide sterilization impairs allograft Incorporati on in a conduction chamber.Clin Orthp,1995,(318):259-264
3 Aspenberg P.Johnsson E,Thorngren KG.Dose-dependent of bone induc-tive prop erties by ethylen oxide. [J] Bone Jiont Surg(Br),1990,72:1036-1037
4 Tsharnala M,Cox E,DeCock H,et al.An-t igenicity of cortical bone allografts in dogs and effect of ethylene oxide-steri lization. Verlmmunol Immunopathol,1999,69.47-59.
5 Jackson DW,Windler GE,Simon TM.In-traarticular associated with the use of freeze-dried,ethylene oxide-sterilized bone-patllar tendon-allografts in the re-con struction of the anterior cruciate ligament. Am [J] Sports Med,1990,18:1-10.
6桑红勋,胡蕴玉,孙怡群,等.环氧乙烷和电离辐射对骨移植材料灭菌效果的对比分析.中华外科杂志，1966 34：457-459
7 Anderson MJ,Keyak JH,Skinner HB.Compressive mechanical properties of hu-man cancellous bone after gamma irradia-15tion. [J] Bone Joint Surg(Am),1992,74:747-752
8 Fideler BM,Vangsness CT Jr,Lu B,et al.Gamma irradiation:efects on biomechanicalprope rties of human bonepa tellar-tendon-16bone allografts. Am [J] Sports Med,1995,23:643-646
9 Campbell DG,Li P. Sterilization of HIVwith irradiation:relevan ce to infe cted bone allografts.Aust N Z [J] Surg.1999.69:517-521
10 Poitout DG. Future of bone allografts in massive bone resection for tumor [J].Presse Med,1996,25(1):527-530
11 Boyee T,Edwards J,Scarbomugh N.Allogrft bone.The influence of precessing on safty and performance [J]. Orthop Clin Noah(Am),1999,30:571-581
12 Conishi H. Orthopaedic applications of hydroxyapatite[J]. Biomate-rials, 1991,12:171
2 潘少川.矫治小儿脊柱侧凸的几种手术介绍和评价.中华骨科杂志,1998,18：324-325
3 Weinstein SL, Dolan LA. Addescent idiopathic seoliosis [J]. Lancet,2008, 371:1527-1537.
4 Heary RF, Madhavan k Genetics of seoliosis[J]. Neurosurgery,2008,3: 222-227.
5 Tang NL, Yeung HY, Lee, A relook into the association of the estrogen receptor[alpha]gene(PvulⅠ,)(baⅠ)and adolescent idiopathic scoliosis:a study of540 Chinese caX Ⅱ[J]. Spine,2006,31:2463-2468.
6 Pooh AM, Cheung KM, Lu DS, dcⅡanges in melatonin receptors in relation to the development of scoliosis in pinealectomised chickens [J]. Spine.2006,31: 2043-2047.
7 Lowe T, Laweilin D, Smith D, et al. Platelet calmodulin levels in adolescent idiopathic scoliosis:do the levels correlate with curve progression and severity [J]. Spine,2002。 27:768-775.
8 Kenanidis E, Potoupnis ME, Papavasiliou KA, et al.Adolescent idiopatllic seoliosis and exewising:is there truly a liaison [J]. Spine,2008.20:2160-2165.
9 Contrel Y. Dubousset J. Gumaumant M. New universal instrulmentation in spinal surgery. Clin Orthop Rel Res,1988,227:10.
10 Esses SI, Bednar DA. The spinal pedicle screw:techniques and systems. Orthop Rev,1989,18:676.682.
11 Burton D C, Sama A A, Asher M A, et al. The treatment of large(>70 degrees)thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis:when is anterior release indicarted?[J]. Spine,2005,30(17): 1979-1984.
12 Kuklo TR, Lenke LG, Won D, et al. Spontaneous proximal thoracic curve correction following fusion of the main thoracic curve in adolescent idiopathic scoliosis[J].Spine,2001,26 (18):1966-1975.
13 Suk SI, Lee SM, Chung ER, et al. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic soliosis[J]. Spine, 2003,28 (5):484-491.
14张永刚,王岩,张雪松,等.特发性脊柱侧凸KingⅢ型和Ⅳ型远端融合椎的选择.中国修复重建外科杂志,2006,20(4)：387-390.
15 Cil A, Pekmezci M, Yazici M,et al. The validity of Lenke criteria for defining structural proximal thoracic curves in patients with adolescent idiopathic scoliosis[J]. Spine.2005,30(22):2550-2555.
16 DobbsMB, Lenke LG, Kim YJ, et al. Selective posterior thoracic fusion for adolescent idiopathic scoliosis:comparision of hooks versus pedicle screws[J]. Spine,2006,31 (20):2400-2404.
17 King HA, Moe JH, Bradford DS, et al. The selection of fusion levels in thoracic idiopathic scoliosis. [J] Bone Joint Surg (Am),1983,65:1302-1313.
18 Benli IT, Akalin S, Kis M,et al. Frontal and Sagittal Balance Analysis of Late Onset Idiopathic Scoliosis Treated with Third Generation Instrumentation. Koe [J] Med Sci,2001,47(6):231-253.
19 Kim YJ。 Lenke LG, BddwelI KH, et al. Pulmonary function in adolescent idiopathic scoliosis relative to the surgicel procedure. [J] Bone Joint Surg Am.2005; 87(7):1534-1541.
20 LI M, Liu Y'Zhu XD。 et al. Zhonghua Guke Zazhi.2004; 24(5):271-275.李明。刘洋,朱晓东.等,一期前路松解后路二维矫形治疗重度僵硬性脊柱侧凸[J].中华骨科杂志，2004.24(5)：271-275.
21 Coe JD, ArIet v. Donaldson W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium:a report of the Scoliosis Research Society Mortality and Morbidity Committee. Spine.2006; 31 f3): 345-349.
22 Newton PO。 Marks M, Faro F, et al Use ofvideo-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine.2003:28(20): S249-254.
23 Kim YJ, Lenke LG. Cho SK, et al. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine.2004; 29(18):2040-2048.
24 Arlet v. Anterior thoracoscopic spine release in deformity surgery:a eta. analysis and review. Eur Spine.2000; 9 Suppl 1:S17-23.
25 Kuklo TR, Lenke LG O'Bden M F, et al. Accuracy and efficacy ofthoracic pedicle screws jn curves more than 90 degrees. Spine.2005:30(2):222-226.
26 Polly D P'PotIer BK. Kuklo Tet al. Volumetric spinal canalintrusion:a comparison between thoracic pedicle screws andthoracic hooks. Spine.2004; 29(11:63-69
27 Kim YJ, Lenke LG, BridwelIKH, et al. Free hand pedicle screw placement in the thoracic spine:is jt safe.Spine.2004; 29(3):333,342.
28 Suk SI, Kim WJ。 Lee SM, et al. Thoracic pedicle screw fixation inspinal deformities:are they really safe.Spine.2001; 26(18):2049-2057.
29 Lonner BS. Ausrbach JD, Estreicher M, et al. Video-assistedthoracoscopic spinal fusion compared with posterior spinal fusion with thoracic pedicle screws for thoracic adolescent idiopathic scoliosis. [J] Bone Joint Surg Am.2009; 91(2): 398-408.
30 Reddi v'Clarke DV Jr,Arlet V Anterior thoracoscopic instrumentation in adolescent idiopathic scoliosis:a systematic review. Spine,2008; 33(18): 1986-1994.
31 Sheron YA. Scoliosis and kyphosis in adolescents:diagnosis and management. Adolesc Med State Art Rev.2007; 18(11:121-139.
32 Smith JR, Sciubba DM, Samdani AF Scoliosis:a straightforward approach to diagnosis and management. JAAPA.2008; 21(11):40-45.
33 Lenke LG Richards S, Stanitski CL. Debate:Resolved, a 55 degree right thoracic adolescent idiopathic scoliotic curve should be treated by posterior spinal fusion and segmental instrumentation using thoracic pedicle screws. [J] Pediatr Orthop.2004; 24:329-341.
34 Han IH。 Chin DK, Kim KS, Short segment antedor correction of adolescent jdiopathic scoliosis. [J] Koraan Neurosurg Soc.2008; 44(1):52-56.
35 Steinmetz M P. Rajpal S, Trost GSegmental spinal instrumentation in the management of scoliosis. Neurosurgery.2008; 63(3 Suppl):131-138.
36 Borgeat A, BlumenthaI S, Postoperative pain management following scoliosis surgery. Curr Opin Anaesthesiol.2008; 21(3):313-316.
37 Yang JS. Sponseller PD. Yazici M, et al. Vascular complications from anterior spine surgery in three patients with Ehlers-Danlos syndrome. Spine.2009; 34(4):E153-157.
38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．中国脊柱脊髓杂志，2003，13：279-282
39史亚民，侯树勋，李利，等．胸椎椎弓根螺钉固定治疗青少年脊柱侧凸．中国脊柱脊髓杂志，2000，lo：200-202
40 Sink EL Karol LA, Sanders J. et al. Efficacy of perioperutive halo-gravity traction in the treatment of severe scoliosis in children. [J] Pediatr Orthop.2001.21:'519-524.
41 Loaner Bs, Murtloy SK. Boachie-Adjei O. Single-staged double anterior and posterior spinal reconstruction for rigid adult spinal deformity:a report of fonr caeses. [J] Spine.2005.5:104-109.
42 Luhmann S, Leanke L. Kim Yiotal. Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees:is anterior re-lease necessary. Spine.2005,15:2061-2067.
43 Arlet V, Jiang L. Ouellet J. Is there a need for anterior release for 70-90 degrees masculine thoracic curves in adolescent scoliosis Euro. [J] Spine.2004.13: 740-745.
44 Burton DC, Sama AA. Asher MA. et al. The treatment of large(>70 degrees)thoracic idiopathic scoliosis curves with posterior imstrume、 ntation and arthrodesis:whwn is anterior release indicated.Spine.2005.30:1979-1984.
45 Hempting A, Ferraris L. Koller H。 et al. Is anterior release effective to increase flexibility in idiopathic thoracic scoliosis,Assessment by traction films. Euro Spine,2007.16:515-520.
46刘洋,李明.重度脊柱侧凸矫形的研究进展.中国脊柱脊髓杂志，2005.15：247-249.
47 Shinichiro Kubo. Naoya Tajima, Etsuo Chosa。 et al. Posterior releasing techigues for idiopathic scoliosis microscpic discectomy and transverse process resection:a technical note. [J] Spinal Disord Tech,2003,16:528.533.
48张宏其.鲁世金,陈静,等.广泛后路松解三维矫形治疗特发性脊柱侧凸.中国脊柱脊髓杂志.2007。17：274-279.
49 Kim YJ, Lenke LG。 Kim J. et al. Comparative analysis of pedicle screw versus hybrid in strumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine.2006,31:291-298.
50 Lenke LG, Kim YI, Rinella AS. Treatment of spinal deformity utilizing thoracic pedicle scrent. Semin Spine Sury,2002,14:66-87.
51 Suk St, Kim WJ. Lee SM, et al. Thoracic pedicle screw fixation inspinal deformites:are they really safe.Spine,2001.26:2049-2057.
52 Kim YJ, Lenke LG. Bridwell KH. et al. Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. [J] Bone Joint Sury Am.2005.87:1534-1541.
53 Hedepuist D, Yeon H, Emon J. The use of allograft as a bone graft substitute in patients with congenital spine deformities[J]. Pediatr Orthop,2007.27:686-689.
54翁爿生,邱贵兴,李军伟,等.同种并体骨与自体骨移植治疗脊柱侧凸的前瞻性研究[J].中华骨科杂志,2004,24：577-580.
55 Newton PO, White KK, Faro F, et al. The saecegs of thomcoscopie anterior fusion in a consecutive series of 112 podiatric spinal deformity cases [J]. Spine, 2005.30:392-398.
56 Kim CW。 Abrams K, Lee G, el al. Use of vascularized fibular graftsas a salvage procedure for prexiotmly failed spinal arthrodesis[J]. Spine,2001.26: 2171-2175.
57 Violas P, Chapuis M。 Braeq}L Local autograft bone in the surgical management of adolescent scoliosis[J]. Spine,2004,29:189-192.
58 Betz RR, Petrizzo AM. Kemer PJ, et al. Allosmft versus no graft with a posterior muhiscgmented hook system for the treatment of idiopathic scoliosis[J]. Spine. 2006,31:121-127.
59 Thompson JP, Transfeldt EE, Bradford DS, et al. Decompensationafter Cotrel-Dubousset instrumentation of idiopathic scoliosis. Spine,1990,15:927-931.
60 Bridwell KH, McAllister JW, Betz RR, et al. Coronal decompensation produced by Cotrel-Dubousset "derotation"maneuver for idiopathic right thoracic scoliosis. Spine,1991,16:769-777.
61 Asher M,Min Lai S, Burton D,et al.The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis [J]. Spine,2003,28(1):63-69.
62 Monticone M, Carabalona R, Negrini S. Reliability of the Scoliosis Research Society-22 Patient Questionnaire (Italian version) in mild adolescent vertebral deformities [J]. Eura Medic-ophys,2004,40(3):191-197.
63 Bago J, Climent JM, Ey A, et al. The Spanish version of the SRS-22 patient questionnaire for idiopathic scoliosis:transcultural adaptation and reliability analysis[J]. Spine,2004,29(15):1676-1680.
64 Alanay A, Cil A, Berk H, et al. Reliability and validity of adapted Turkish Version of Scolio-sis Research Society-22 (SRS-22) questionnaire [J]. Spine, 2005,30(21):2464-2468.
65赵黎.张勇.尚磊等,中文版SRS-22问卷在中国青少年特发性脊柱侧凸患者评价中的应用[J].中华矫形外科杂志，2008,7：1072-1073.
1 张永刚,王继芳,卢世壁等,现代骨库的标准和规章制度.中华骨科杂志，2000,20期刊：87-88
2 Thoren K,Aspenberg P.Ethylene oxide sterilization impairs allograft Incorporati on in a conduction chamber.Clin Orthp,1995,(318):259-264
3 Aspenberg P.Johnsson E,Thorngren KG.Dose-dependent of bone induc-tive prop erties by ethylen oxide. [J] Bone Jiont Surg(Br),1990,72:1036-1037
4 Tsharnala M,Cox E,DeCock H,et al.An-t igenicity of cortical bone allografts in dogs and effect of ethylene oxide-steri lization. Verlmmunol Immunopathol,1999,69.47-59.
5 Jackson DW,Windler GE,Simon TM.In-traarticular associated with the use of freeze-dried,ethylene oxide-sterilized bone-patllar tendon-allografts in the re-con struction of the anterior cruciate ligament. Am [J] Sports Med,1990,18:1-10.
6桑红勋,胡蕴玉,孙怡群,等.环氧乙烷和电离辐射对骨移植材料灭菌效果的对比分析.中华外科杂志，1966 34：457-459
7 Anderson MJ,Keyak JH,Skinner HB.Compressive mechanical properties of hu-man cancellous bone after gamma irradia-15tion. [J] Bone Joint Surg(Am),1992,74:747-752
8 Fideler BM,Vangsness CT Jr,Lu B,et al.Gamma irradiation:efects on biomechanicalprope rties of human bonepa tellar-tendon-16bone allografts. Am [J] Sports Med,1995,23:643-646
9 Campbell DG,Li P. Sterilization of HIVwith irradiation:relevan ce to infe cted bone allografts.Aust N Z [J] Surg.1999.69:517-521
10 Poitout DG. Future of bone allografts in massive bone resection for tumor [J].Presse Med,1996,25(1):527-530
11 Boyee T,Edwards J,Scarbomugh N.Allogrft bone.The influence of precessing on safty and performance [J]. Orthop Clin Noah(Am),1999,30:571-581
12 Conishi H. Orthopaedic applications of hydroxyapatite[J]. Biomate-rials, 1991,12:171