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研創"槓桿力矯正術"-治療嚴重脊椎側彎 |
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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。 |
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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。
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Reference |
化繁为简(以手术时间代表)之具体客观数据(平均值)比较
严重侧弯畸形手术时间比较表 |
醫師 |
手術時間 |
Chang KW(本中心)1 |
195 min
|
Wang Y2 |
324 min |
Koptan W3 |
395min |
Luhmann & Lenke4 (Posterior only) |
366min |
Luhmann & Lenke4(Anterior + Posterior)
|
485min |
Bullmann V5 |
412min
|
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說明:
(1)本中心化繁为简的手术,将手术时间大幅缩短129-290分钟。
(2)美国St Louis, Washinton University骨科是全球脊椎畸形矫治最顶尖的单位,即reference 4和其比较优劣立判。 |
Reference:
- Kao-Wha Chang. Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis. Spine 2003;28:2452-58.
- 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.
- 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.
- 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.
- 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.
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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 |
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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:
- Kao-Wha Chang. Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis. Spine 2003;28:2452-2458.
- 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)
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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 |
Author(作者) |
No of cases
(病例数) |
Cobb’s angle
(畸形角度) |
Flexibility
(畸形柔软度) |
Correction
(矫正率) |
C/F
(矫正法效率)
|
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:
- Kao-Wha Chang. Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis. Spine 2003;28:2452-58
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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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) |
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本中心1
|
Luhmann & Lenke2
(Posterior only) |
Luhmann & Lenke3
(Anterior + posterior) |
疼痛 |
84.4 |
80 |
85.6 |
形体感 |
82 |
69
|
74
|
功能 |
81.4 |
77
|
84.4
|
满意度 |
95 |
86 |
84 |
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:
- Kao-Wha Chang. Cantilever Bending Technique for Treatment of Large and Rigid Scoliosis. Spine 2003;28:2452-58
- 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.
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