Surgical treatment of scoliosis associated with Chiari malformation / 中国矫形外科杂志

[Objective]To discuss the diagnosis and treatment method of scoliosis associated with Chiari malformation.[Method]Twelve patients were suffered from scoliosis associated with Chiari malformation,in which there were 7 patients also complicated with syringomyelia.Firstly,posterior suboccipital craniectomy to enlarge foramen occipital magnum was performed,then the patients underwent the scoliosis correction with instrumentation.[Result]Preoperatively,the mean Cobbs angle on the coronal plane was 71?,and 24? postoperatively,with an average correction of 66%.During a follow-up from 1 year to 4 years,there were no release of the hook,no breaking of pedicle screw,no false articulation and no new nervous lesion,while few improving was found about the sensory disability and superficial abdominal hyporeflexia.[Conclusion]We should first consummate the examination and make a definite diagnosis for the patients who were suffered from scoliosis associated with Chiari malformation and syringomyelia;posterior suboccipital craniectomy to enlarge foramen occipital magnum or syrinx-subarachnoid space shunting should be performed firstly to reduce nervous lesion during scoliosis correction surgery.

Reconstruction of truck balance function in severe scoliolosis patients with Marfan syndrome / 中国组织工程研究

BACKGROUND: Most of the scoliolosis patients with Marfan syndrome are young, and in the growth and development period. Scoliosis develops rapidly, so a great number of patients need operation. Many patients accompanied with severe cardiorespiratory disfunction, which brings about a great difficulty for operation.OBJECTIVE: To observe the effect of CD orthosis on spinal function of patients with Marfan syndrome.DESIGN: A self-control observation.SETTING: Department of Orthopaedics, Renji Hospital Affiliated to Medical College, Shanghai Jiao Tong University (i.e. Shanghai Second Medical University).PARTICIPANTS: A total of 8 severe scoliolosis patients with Marfan syndrome who were treated at Department of Orthopaedics, Renji Hospital Affiliated to Medical College, Shanghai Jiao Tong University (i.e. Shanghai Second Medical University) were enrolled from May 1999 to July 2003. Of them, there were 2 one-side curvatures, 6 two-side curvatures; 4 cases of cardiorespiratory function lost lightly, 2 cases midrange lost. Mean Cobb angle was 88°.METHODS: The patients were at prone position under general anesthesia.Incision was made at middle posterior after fixing the position. Erector spinal muscle beneath periosteum was stripped and vertebral plate to transverse process root was revealed. Claws or nails were used in multiple segments of vertebrae by CD orthosis such as CD, CD-Horison, TSRH, USS and so on.MAIN OUTCOME MEASURES: Changes of Cobb angle, height, grafting bone fusion and cardiorespiratory function of patients after operation.RESULTS: After 12-month follow-up, 8 patients were involved in the result analysis. The incision of 8 patients was healed, no infection. Scoliolosis was corrected effectively, and the height increased by 5-8 cm. Cardiorespiratory function recovered satisfactorily after operation. Grafting bone was fused. The lost Cobb's angle was less than 25° after correction.CONCLUSION: CD orthosis can correct the lateral curvature and effectively correct that of patients combined with rotational deformity, consisting of large distraction, multiple segment frame style fixation, average distributed force placement, so it is not easy to have the complications such as release, broken stick and so on. Selective multiple segment fixation and derotation are adopted, so good three-dimension correction is gained, which can reconstruct satisfactorily trunk balance, prevent post-operative loss,with less complication, high fusion rate, less correction lost. External fixation is not needed after operation, which is helpful for early rehabilitation.