Theo dõi lâu dài hiệu quả phẫu thuật nắn chỉnh và cố định vẹo cột sống tại đơn vị cột sống Bệnh viện Trưng Vương=Long - term follow - up of treatment effectiveness for scoliosis correction and fixation surgery at the spine unit

Theo dõi lâu dài hiệu quả phẫu thuật nắn chỉnh và cố định vẹo cột sống tại đơn vị cột sống Bệnh viện Trưng Vương=Long - term follow - up of treatment effectiveness for scoliosis correction and fixation surgery at the spine unit - Trung Vuong Hospital

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Nhựt Tâm Hồ, Chí Hùng Huỳnh, Minh Tâm Huỳnh, Thanh Trọng Phan, Văn Thành Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.318-324

Bộ sưu tập: Báo, Tạp chí

ID: 243575

Thêm vào giỏ

Đánh giá kết quả phẫu thuật nắn chỉnh, cố định vẹo cột sống cấu hình toàn ốc chân cung tại Đơn vị Cột sống, Bệnh viện (BV) Trưng Vương. Phương pháp nghiên cứu: Hồi cứu, mô tả loạt ca. Kết quả: Phương pháp phẫu thuật: (1) Cố định nắn chỉnh lối sau: 32 ca (94%), (2) Giải phóng lối trước và cố định lối sau 2 thì với hai thanh nối: 1 ca, (3) Giải phóng lối trước và cố định lối sau 2 thì với ba thanh nối: 1 ca. Có 34 ca gồm nữ 26 ca và nam 8 ca. Tuổi trung bình: 17,6 tuổi. Nguyên nhân gồm vô căn: 14 ca, hội chứng: 14 ca, bẩm sinh: 5 ca, sẹo co rút: 1 ca. Vẹo cột sống nặng (40 - 600): 14 ca, VCS rất nặng (>
600): 20 ca. Vị trí vẹo: ngực chính (24 ca), thắt lưng chính (10 ca). Thời gian trung bình theo dõi lần cuối: 12,4 tháng. Độ nắn chính sau mổ trung bình: 66,5%. Cao thêm sau mổ: +2,7 cm. Mất độ nắn chỉnh trung bình theo dõi lần cuối: 0,30. Biến chứng: tràn máu màng phổi (1 ca), liệt một phần chân phải do ốc đặt bể thành trong chân cung TL1 phải (1 ca), mổ lại để chỉnh sửa vai cân (1 ca), mổ lại do ốc chân cung N10 bên trái thủng thành trước, đầu ốc gần động mạch chủ (1 ca). Kết luận: Đánh giá trước mổ VCS rất quan trọng cho việc chọn lựa phương pháp mổ cũng như cấu hình nắn chỉnh vẹo phù hợp. Phẫu thuật nắn chỉnh - cố định với cấu hình toàn ốc chân cung với y lược các điểm đặt ốc đúng thì cấu hình vững, ít mất độ nắn chỉnh. Kỹ thuật đặt ốc chân cung hình phễu cải biên áp dụng đúng mức không cần màn tăng sáng, giảm tỉ lệ biến chứng đặt ốc.The purpose of this study is to assess the results of scoliosis surgery at the Spine Unit, Trung Vuong hospital since 2017. Methods: Retrospective, case-series study. Results: Surgical method: Posterior correctionfixation: 32 cases (94%), two-stage anterior releasing and posterior correctionfixation with double rods system: 1 case, twostage anterior releasing and posterior correctionfixation with triple rods system: 1 case. Patients data: Gender: Female: 26 cases, Male: 8 cases. Average age: 17.6 y.o. Etiologies include idiopathic: 14 cases, syndrome: 14 cases, congenital: 5 cases, scar constricture: 1 case. Severity: Severe scoliosis (40 - 600): 14 cases and very severe scoliosis (>
600): 20 cases. Classification: main thoracic scoliosis 24 cases and main lumbar scoliosis 10 cases. The mean follow-up: 12.4 months. Average postop correction rate: 66.5%. Post-op height increase: +2.7 cm. Loss correction follow-up: 0.30. Complications: Hemothorax: 1 case, partial paraplegia due to medially inserted displacement of right L1:1 case, revision surgery to correct shoulder balance: 1 case, removing surgery of T10 screw penetrated the anterior body cortex with its tip close to the aorta: 1 case. Conclusion: Preoperative assessment of scoliosis is very important for choosing the appropriate surgical method as well as the appropriate pedicle construction for scoliosis correction. Posterior correction-fixation surgery with whole pedicle screws construct and precise entry point offer good stability, with little change after longterm follow-up. The modified natural anatomical technique to insert pedicle screws allows freehand without the use of C-arm reduces the complications.

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