摘要
目的比较特发性脊柱侧凸King、Lenke和PUMC分型的全面性及其对手术的指导价值。方法回顾性分析在巴塞罗那SantJoanDeDéu医院接受手术治疗的特发性脊柱侧凸患者145例的临床及影像学资料。所有病例均进行King、Lenke和PUMC分型,比较手术原则与三种分型方法的符合率及术后失代偿的发生情况。结果King分型能对全部病例中的122例进行分型,有23例无法应用King分型;而Lenke分型和PUMC分型均能对全部病例进行分型。145例患者中,手术原则符合King分型者99例(68.3%),符合Lenke分型者120例(82.8%),符合PUMC分型者107例(73.8%)。95例患者随访3～96个月,平均29.6个月。其中手术原则符合King分型、Lenke分型和PUMC分型融合范围而于术后与随访时发生冠状面躯干失平衡(失代偿)的发生率分别为26.3%(26/99)和13.2%(9/68)、30.8%(37/120)和12.5%(10/80)、14.0%(15/107)和2.7%(2/74),符合PUMC分型而发生冠状面躯干失平衡的发生率与符合King分型、Lenke分型者比较差异均有统计学意义(P<0.05)。上胸弯和主胸弯的柔韧性与胸腰弯和腰弯比较差异有统计学意义(P<0.05)。结论特发性脊柱侧凸的PUMC分型与Lenke分型比King分型更全面,PUMC分型比King分型和Lenke分型更具手术指导意义。对不同部位的脊柱侧凸采用统一的凸侧Bending位X线片上Cobb角超过25°来定义结构性侧凸并不合适。
Objective To compare the comprehension and the role of King, Lenke and PUMC classifications in the surgical treatment of adolescent idiopathic scoliosis. Methods Medical records and radiographs of 145 patients who underwent surgical treatment in Hospital Sant Joan De Déu were reviewed. Each patient was classified according to the different classifications and related fusion levels, and postoperative decompensation was analyzed. Results All the 145 cases could be classified by Lenke and PUMC classifications. Only 122 cases could he classified according to King classification. The fusion levels were coincided with King classification in 99 cases, Lenke classification in 120 cases and PUMC classification in 107 cases. 95 patients followed up regularly, with an average of 29.6 months （range, 3 to 96 months）. The rates of coronal decompensation after operation and at final follow-up were 26.3% （26/99） and 13.2% （9/68）, 30.8% （37/ 120） and 12.5% （10/80）, 14.0% （15/107） and 2.7% （2/74） when fusion level meeting with the criteria of King classification, Lenke classification and PUMC classification, respectively. There were significant differences of the coronal decompensation rates between PUMC and King or Lenke classification （P 〈 0.05）. The flexibility of the proximal thoracic and main thoracic curves were different from those of the thoracolumbar and lumbar curves （P 〈 0.05）. Conclusion Of the three classifications, PUMC and Lenke classifications are more comprehensive than King classification, and PUMC classification is more practical in the selection of fusion levels than the two others. It＇s not appropriate to use the same criterion of Cobb angle larger than 25° on the convex Bending film as a definition of structural curve for different curves in the different sites.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第3期145-150,共6页
Chinese Journal of Orthopaedics
