| ObjectiveScoliosis is the common adolescent spinal deformity, female is more comm-on, the operation is an important therapeutic tool, the treatment methods developed from Harrington,Luque to CD, for pedicle screws have better mechanics stability and fixed intension, screw-stick system has replaced hook-stick system gradually. The correction surgery for scoliosis involves large trauma and long operation time, and it may lead to great blood loss because of the exposure and dissection of much tissue, blood transfusion of large amount of blood is necessary. In order to soften the problem of limited blood source, cut cost of blood transfusion, avoid massive transfusion of allogeneic blood and reduce incidences of complications induced by massive transfusion, infusion of allogeneic stock blood should be avoided as far as possible. To discuss the application of pedicle screws that served as internal fixation device in the three dimensional correction of scoliosis, fusion of graft bone and posterior internal fixation. To conduct a retrospective analysis on the outcome of surgery during or after surgery, evaluate its safety and efficacy, and to discuss the value of employing controlled hypotension combined autoreinfusion in idiopathic scoliosis (IS) orthomorphia.MethodsThe SRS diagnostic criteria define scoliosis as the degree of the curve≥10 degrees in the plain film. The indications of surgery are as follows: 1. The progress of scoliosis failed to be controlled by brace treatment, and the scoliosis assumes progressive aggravation tendency, with annual curve increase > 5 degrees; 2. The Cobb angle of patients is > 40 degrees complicated with thoracic lordosis, rotation of thoracic cage, razor back deformity, decompensation of truncal obliquity etc. 3. Appearances of low back pain, vertebral body rotation semiluxation etc. in early stage of adult scoliosis. 4. congenital scoliosis should be operated as early as possible.A total of 75 patients with scoliosis which have follow-up information received surgery in our department between June 2003 and Dec. 2006, of which, 48 received pan-vertebral pedicle screws fixation orthomorphia. During surgery, controlled hypotension combined with autoreinfusion was performed, the patients'blood pressure were controlled near 90±5mmHg, the methods of autoreinfusion include beforehand autoreinfusion preoperative and blood reclaim refusion in the operation, the insertion of vertebral pedicle screws was performed by free-hand technique, and surgery like three diamensions correction of scoliosis, graft bone fusion, stabilization of spine and elimination of deformity of appearance were also performed. No drainage was placed after surgery. But the patients were asked to wear thoracolumbar brace for 3 months as a protection. Regular follow-up was scheduled at 1, 3, 6 and 12 months after hospitalization, thereafter an annual follow-up was scheduled. The major outcome measures during follow-up were the clinical findings, correction of deformity, X-ray imaging findings before and after surgery and at the last time of follow-up, with correction of deformity and progression analyzed.The major outcome measures in our study were the correction situation of scoliosis following pan-vertebral pedicle screws fixation and the curative effects of controlled hypotension combined with autoreinfusion.ResultsThe operated time 160~395min, the mean time was 277±21min. the amountof blood was 350 ml～2100 ml, the mean blood transfusion was 670±43ml. The amount of pedicle screw were 696, the highest vertebral body wasT2, and the lowest wasS1, Complications of nerves, internal organs and injury of great vessels were not seen. The patients were followed for 6 to 38 months (mean 18 months). The mean Cobb angle before vs. after surgery was 63.6 vs. 20.5 degrees, with correction rate of 66.4%; the side-shift of trunk before vs. after surgery was 5.6cm (2.8～9.8cm) vs. 2.0cm (0.5～5.6cm), with correction rate of 64.3%; the compensation Cobb angle before vs. after surgery was 33.2 and 16.4 degrees, with automatic correction rate of 50.6%; The loss of right angle at the last time of follow-up was 2.8 (1-12) degrees. The mean growth in stature was 5 (2-9) cm. There were 5-13 vertebrae in fusion segment, with an average of 10. Complications of pseudoarticulation formation, broken screws and sticks or screws extration were not seen. After surgery, 3 had segmental curvature other than the fusion area of spine after surgery, of whom, 2 were thoracic curvature and 1 were upper thoracic curvature.In patients receiving controlled hypotension combined with autoreinfusion, the blood loss was significantly reduced, the amount was from 800～4100ml to 350～2100ml and the economical burden of the patients were lessened. The infused volume of allogeneic stock blood was reduced by 51.1%, of whom, none had transfusion reaction, and reduced The hemoglobin level at 24h and 7d after surgery showed a reduction as compared with before surgery, and the patients showed a mild anaemia, but no related clinical symptoms appeared.Conclusion1. Pedicle screws fixation provides powerful corrective force, and can enhance the efficacy of spinal deformity correction.2. Pedicle screws can strengthen control the vertebral body which has rotation deformity and reduce the incidence of crankshaft phenomenon.3. Pedicle screws have powerful control force on vertebral body, which can reduce the postoperative loss of the right angle.4. Employing controlled hypotension can help reduce blood loss and create a clear operating field for the benefit of operation.5. Through autoreinfusion, the transfusion of allogeneic stock blood volume was reduced, incidences of complications induced by transfusion were reduced, transmission of diseases via blood were avoided, meanwhile the waste of autoblood was reduced and the economical burden of the patients were lessened. |
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