Adölesan idiyopatik skolyozun anterior enstrümantasyon ile tedavisi ve erken sonuçlar

GÖĞÜŞ ,Abdullah; AKMAN ,Şenol; TALU ,Ufuk; ŞAR ,Cüneyt; HAMZAOĞLU ,Azmi

Abdullah GÖĞÜŞ

(Kadir Has Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, İstanbul, Türkiye)

Şenol AKMAN

(Şişli Etfal Eğitim ve Araştırma Hastanesi, 2. Ortopedi ve Travmatoloji Kliniği, İstanbul, Türkiye)

Ufuk TALU

(İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, İstanbul, Türkiye)

Cüneyt ŞAR

(İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, İstanbul, Türkiye)

Azmi HAMZAOĞLU

(İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, İstanbul, Türkiye)

Acta Orthopaedica et Traumatologica Turcica

Yıl: 2001Cilt: 35Sayı: 3ISSN: 1017-995XSayfa Aralığı: 196 - 207Metin Dili: Türkçe

123 2

Türkçe
İngilizce

Adölesan idiyopatik skolyozun anterior enstrümantasyon ile tedavisi ve erken sonuçlar

Öz: Amaç: Üçüncü kuşak anterior vida;tek çubuk sistemleri ve intervertebral titanyum mesh kullanılarak tedavi edilen adölesan idiopatik skolyozlu olgularda erken dönem tedavi sonuçları değerlendirildi. Çalışma planı: Adölesan idiopatik skolyozlu 17 hasta (15 kadın, 2 erkek; ort. Yaş 14.9:dağılım 11-20) değerlendirildi. Eğrilikler dört olguda King tip I, altı olguda tip II, iki olguda tip III, iki olguda tip IV ve üç olguda lomber olarak sınıflandırıldı. Lomber olgularda tüm seviyelerde, torakal olgularda ise enstrümantasyonun kranial ve kaudal sınırlarında intervertebral titanyum mesh$ler kullanıldı. Tüm olgular ameliyat sonrası 3-6 ay süreyle torakolumbosakral ortez içinde immobilize edildi. Hastaların ameliyat öncesi, ameliyat sonrası ve takiplerinde iki yönlü orthoröntgenografileri değerlendirildi. Ortalama takip süresi 28 ay (dağılım 18-41 ay) idi. Sonuçlar: Koronal eğrilik derecesi ortalamaları ameliyat öncesinde 51, ameliyat sonrasında 8.6 bulundu. Koreksiyon oranı ortalaması %83.9 idi. Ameliyat sonrası sagital açı değerleri ortalaması torakal kifoz için 27.5, lomberlordoz için 37.6 bulundu. Sekonder eğriliklerin hiçbirinde dekompensasyon gelişmedi. Posterior enstrümantasyon ile karşılaştırıldığında ortalama 0.93 seviye füzyondan tasarruf edildi. Torakolomber geçiş bölgesi kifozu saptanmadı. Bir torasik olguda vida sıyırması nedeniyle, erken dönemde posterior enstrümentasyon ile revizyon uygulandı. Takiplerde psödoartroz, implant yetersizliği ve koreksiyon kaybı gibi problemlerle karşılaşılmadı, Çıkarımlar: Sonuçlarımız üçüncü kuşak anterior tek çubuk enstrümentasyon ve intervertebral titanyum mesh'lerin adölesan idiopatik skolyozun cerrahi tedavisinde posterior enstrümentasyona iyi bir alternatif olduğunu gösterdi.

Anahtar Kelimeler: Torasik omurga Skolyoz Ergenlik Omurilik füzyonu Lumbar omurga Lordoz Kifoz Kemik çivileri

Konu Alanı:

Early results of anterior instrumentation in adolescent idiopathic scoliosis

Abstract:Objectives: We evaluated early results of treatment in patients with adolescent idiopathic scoliosis, who underwent anterior fusion with rigid single-rod third generation instrumentation and titanium surgical mesh implants. Methods: Seventeen patients (15 females, 2 males; mean age 14.9 years; range 11 to 20 years) with adolescent idiopathic scoliosis were included. Of the patient group, four had King type I, six had King type II, two had King type III, two had King type IV, and three patients had lumbar curves. Titanium mesh cages were used in all lumbar procedures, and at the cranial and caudal ends of the instrumented area in thoracic cases. All patients were immobilized in a TLSO for three to six months postoperatively. Preoperative, postoperative and follow-up ortho-radiographs were evaluated. The mean follow-up was 28 months (range 18 to 41 months). Results: The mean pre- and postoperative primary coronal Cobb angles were 51$\circ$ and 8.6$\circ$, respectively. The mean correction was 83.9%. Sagittal balance was also restored with mean angles of 27.5$\circ$ and 37.6$\circ$ for thoracic kyphosis and lumbar lordosis, respectively. Spontaneous secondary curve decompensation did not occur. Compared with posterior surgery, the mean number of lumbar levels saved was calculated as 0.93. Postoperative thoracolumbar junctional kyphosis did not develop. Loss of correction, nonunion, and implant failure were not encountered; however, one thoracic case required revision with posterior surgery for proximal screw pull-out. Conclusion: Our early results indicate that anterior correction using third generation single solid rod instrumentation and titanium mesh cages offers a good alternative to posterior instrumentation.

Keywords: Thoracic Vertebrae Scoliosis Adolescence Spinal Fusion Lumbar Vertebrae Lordosis Kyphosis Bone Nails

Subject Area: SCIENCE > MEDICINE > ORTHOPEDICS
SCIENCE > MEDICINE > SURGERY

Belge Türü: DergiMakale Türü: DiğerErişim Formatı: Erişime Açık

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