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研創"槓桿力矯正術"－治療嚴重脊椎側彎

对于大角度、坚硬严重的侧弯畸形，国际通常的作法是先经由胸腔、腹腔，切开横膈膜作脊椎前方松解(Anterior release)，再由后方以内固定器矫正(Instrumentation and correction)。本中心经多年之研究于2003年率先发表杠杆力矫正法，只需由后方先以多个椎弓根钉建立稳固基桩，再以杠杆力矫正法提供强大的三度空间矫正力以对抗畸形力，可安全的达成理想的矫正，免除了前方松解大手术，简化手术并免除其相关的并发症，提高了手术之安全性且矫正效果更好，此外，杠杆法中并设计了固定神经组织长度的步骤方法，避免神经在矫正过程中被拉扯导致神经损伤，大幅提高了神经安全性。

杠杆法之手术步骤

手术矫正实例－22岁女性术前153°脊椎侧弯畸形，仅由后方以杠杆法矫正至近乎正常且增高15公分，免除了前方大手术之必要，简化手术，提升安全且疗效更佳。

Reference

1. Chang KW. Cantilever bending technique for treatment of large and rigid scoliosis.Spine 2003;28:2452-48.
2. 张国华,林建中,陈鸿昌,et al.杠杆力矫正法治疗重度僵硬的脊柱侧凸畸型。 中华骨科杂志2007;27(1):43-48.

Reference:

1. Kao-Wha Chang. Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis. Spine 2003;28:2452-58.
2. Yan Wang, Yongguang Zhang, Xuesong Zhang, et Al. A Single Posterior Approach for Multilevel Modifier Vertebral Column Resection in Adults with Severe Rigid Congenital Kyphoscoliosis. Eur Spine,17(3)361-72,2008.
3. Koptan W, Elmiligui Y. Three-Stage Correction of Severe Rigid Idiopathic Scoliosis Using Limited Halo-Gravity Traction. Eur Spine J. 2011 Dec 13. DOI 10.1007/s00586-011-2111-0.
4. Scott J. Luhmann, Lawrence G. Lenke, Yongjung J. Kim, et al. Financial analysis of circumferential fusion versus posterior-only with thoracic pedicle screw constructs for main thoracic idiopathic curves between70° and 100°. J Child Orthop. 2008 March; 2(2): 105-112.
5. Viola Bullmann, Henry F. H. Halm, Tobias Schulte, et al. Combined Anterior and Posterior Instrumentation in Severe and Rigid Idiopathic Scoliosis. Eur Spine J (2006)15:440-448.

转危为安(以并发症为代表)之具体客观数据(平均值)比较
侧弯畸形并发症比较表

台灣脊椎中心¹

國際²

死亡

0

0.1%

硬脊椎膜损伤

0

0.4%

感染

1.2%

2.7%

神经损伤

0

1%

肺栓塞

0

0.04%

肺炎、气胸、血胸

2%

1%

内固定器断裂

0

1.5%

硬脊膜上腔血肿

0

0.02%

Reference:

1. Kao-Wha Chang. Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis. Spine 2003;28:2452-2458.
2. Davis L. Reames, Justin S. Smith, Kai-Ming G. Fu, et al. Complications in the Surgical Treatment of 19,360 Cases of Pediatric Scoliosis. Spine 2011;36:1484-1491. (此为美国脊椎侧弯研究学会之统计研究报告)

疗效更好(以矫正率及以美国脊椎侧弯学会临床治疗结果问卷评分为代表)之具体客观数据(平均值)比较
严重侧弯畸形矫正率比较表

Chang KW¹⁽本中心)

41

98°

18%

64%

3.6

Arlet V²

15

75°

29%

54%

1.9

Koptan W³

32

102°

40%

61%

1.5

Wang Y⁴

16

89°

29%

57%

2.0

Dobbs & Lenke⁵
(Posterior)

34

94°

34%

44%

1.2

Dobbs & Lenke⁵
(Anterior + posterior)

20

92°

32%

44%

1.4

Luhmann & Lenke⁶

62

77°

39%

51%

1.3

Bullmann⁷

33

93.4°

23%

65%

2.8

說明：
(1)本中心病例畸形角度最大(Cobb angle大)、最坚硬(Flexibility小)，但矫正率最大(Correction大)，矫正术之矫正效率最大(C/F较大)。
(2)reference 5为美国St Louis, Washinton University骨科(为全球脊椎畸形矫正最顶尖的单位)之研究论文报告。
Reference:

1. Kao-Wha Chang. Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis. Spine 2003;28:2452-58
2. Arlet V, Jiang L, Ouellet J. Is There a Need for Anterior Release for 70-90 Degrees Thoracic Curves in Adolescent Scoliosis? Eur Spine J. 2004 Dec;13(8):740-5. Epub 2004 Dec 22.
3. Weal Koptan and Yasser Elmiligui. Surgical Correction of Severe Dystrophic Neurofibromastosis Scoliosis: an Experience of 32 Cases. Eur Spine J. 2010 September; 19(9): 1569-1575.
4. Yan Wang, Guoquan Zheng, Xuesong Zhang, et al. Comparative Analysis Between Shape Memory Alloy-Based Correction and Traditional Correction Technique in Pedicle Screws Constructs for Treating Severe Scoliosis. Eur Spine J. 2010 March; 19(3): 394-399.
5. Matthew B. Dobbs, Lawrence G. Lenke, Yongjung J. Kim, et al. Anterior/Posterior Spinal Instrumentation Versus Posterior Instrumentation Alone for the Treatment of Adolescent Idiopathic Scoliotic Curves More Than 90°. Spine 2006;31:2386-2391.
6. Scott J. Luhmann, Lawrence G. Lenke, Yongjung J. Kim, et al. Thoracic Adolescent Idiopathic Scoliosis Curves Between 70° and 100°. Spine 2005;30:2061-2067.
7. Viola Bullmann, Henry F. H. Halm, Tobias Schulte, et al. Combined Anterior and Posterior Instrumentation in Severe and Rigid Idiopathic Scoliosis. Eur Spine J (2006)15:440-448.

严重侧弯畸形手术矫正临床结果评估比较表(以SRS outcome score美国脊椎侧弯学会临床结果问卷评分)

說明：
(1)各项以分数高者为优
(2)为美国St Louis, Washinton University骨科(为全球脊椎畸形矫正最顶尖的单位)之研究论文报告 Reference: 2.3为美国St Louis, Washinton University骨科(为全球脊椎畸形矫正最顶尖的单位)之研究论文报告
Reference:

1. Kao-Wha Chang. Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis. Spine 2003;28:2452-58
2. Scott J. Luhmann, Lawrence G. Lenke, Yongjung J. Kim, et al. Thoracic Adolescent Idiopathic Scoliosis Curves Between 70° and 100. Spine 2005 Sep 15;30(18):2061-7.