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DOI: 10.1055/s-2002-22095
© Georg Thieme Verlag Stuttgart · New York
Langzeitergebnisse dorsaler Instrumentationsspondylodesen mit dem Cotrel-Dubousset-Instrumentarium bei idiopathischen Thorakalskoliosen
Long-term results of posterior correction and fusion of scoliosis using the Cotrel-Dubousset instrumentationPublication History
Publication Date:
15 March 2002 (online)
Zusammenfassung
Ziel: Erfassung der Langzeitergebnisse nach CDI. Methode: Retrospektive Auswertung von 43 Patienten mit idiopathischer rechts-konvexer Thorakalskoliose bei einem durchschnittlichen Nachuntersuchungszeitraum von 82 Monaten. Umfangreiche radiometrische Analyse mit Schwerpunkt auf der Krümmungskorrektur in der frontalen und der sagittalen Ebene. Ergebnisse: Die präoperative Primärkrümmung betrug 61,6° (Min.: 40°, Max.: 84°) nach Cobb und konnte um durchschnittlich 51,5 % auf 29,9° korrigiert werden. Aufgrund des Korrekturverlustes von 7,1° betrug die Korrektur zum Nachuntersuchungszeitpunkt 39,9 %. Mehr als 90 % des Korrekturverlustes trat in den ersten beiden postoperativen Jahren auf. Die untere Gegenkrümmung konnte im Mittel um 47,2 % korrigiert werden (prä-op: 37,5°; post-op: 19,8°). Die Fusionsstrecke endete im Mittel 2 Segmente unterhalb des distalen Endwirbels. Die Korrektur der Scheitelwirbeltranslation betrug 38,8 % (präop: 4,9 cm; postop: 3,0 cm), die der Schrägstellung des letzten instrumentierten Wirbels 44,2 % (prä-op: 18,2°; postop: 10,16°). Es konnte lediglich eine geringe Derotation erzielt werden (prä-op: 24,1°; post-op: 22,6°). Die Wiederherstellung eines physiologischen sagittalen Profils bei präoperativ pathologischer BWS-Hypokyphosierung gelang in 12 von 15 Fällen. Komplikationsrate, Blutverlust und OP-Dauer wurden dokumentiert. Schlussfolgerung: Das CD-Instrumentarium bietet langfristig zufriedenstellende Korrekturmöglichkeiten in der frontalen und gute Korrekturergebnisse in der sagittalen Ebene. Korrekturstabilität wird jedoch erst nach 2 Jahren erzielt.
Abstract
Aim: Radiographic analysis of long-term results following CDI. Methods: Retrospective analysis of radiographs of 43 patients with idiopathic right thoracic scoliosis with an average follow-up of 82 months. Extensive radiographic analysis with special regard to curve correction in the frontal and sagittal planes. Results: The average Cobb-angle of the preoperative primary curve was 61.6° (min.: 40°, max.: 84°), the correction postoperatively was 51.1 % representing 29.9°. Due to the loss of correction of 7.1°, the overall outcome was 39.9 % by the time of follow-up. More than 90 % of the loss of correction occurred within the first 2 years. The lumbar secondary curve correction was 47.2 % (preop.: 37.5°; postop.: 19.8°). Average fusion length was 11 segments, fusion usually ended two vertebrae below the end vertebra. Translation of the apex was corrected by 38.8 % (preop.: 4.9 cm; postop.: 3.0 cm), tilt of the last instrumented vertebra by 44.2 % (preop.: 18.2°; postop.: 10.16°). The amount of derotation was negligible (preop.: 24.1°; postop.: 22.6°). The readjustment of a preoperative pathologic sagittal profile, meaning a thoracic hypokyphosis, was successful in 12 out of 15 cases. Blood loss, duration of operation and complications were documented. Conclusion: CD-Instrumentation in scoliosis surgery offers a long-lasting suffcient correction of the fronal and a good correction of the sagittal plane. Stability of correction is achieved 2 years after operation.
Schlüsselwörter
Skoliose - CD-Instrumentation - Langzeitergebnisse
Key words
Scoliosis - CD-Instrumentation - Long-term Results
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Dr. med. Ulrich Lepsien
Klinik und Poliklinik für Allg. Orthopädie des
Universitätsklinikums Münster
Albert-Schweitzer-Str. 33
48149 Münster
Phone: 0251/8347971
Fax: 0251/8348593
Email: ortho@uni-muenster.de