| Paralytic Scoliosis(PS) pertains to coronal plane deformity of the spine in patients with abnormalities of the spinal cord and neural pathways of the body. The disorders which cause this type of deformity mainly comprise the poliomyelitis in our country,others comprise congenital or acquired trouble and injury of spinal cord and peripheral nerve.PS is found at every age group and shows diverse scoliosis deformities,because of spinal flaccidity and inbalance of spinal constitution and posture.Paralytic scoliosis curve patterns are due to compromise in the muscular function of dynamic support for vertebral column stability and muscular flaccidity with inbalance and secondary contractures. There are many diffculty in the operative treatment of patients with paralytic scoliosis because of a number of additional factors,the muscular flaccidity can't keep balance of the trunk;the patients are commonly in a debilitated state of health and poor nutritional status,comprise cardial and respiratory function, which manifest dysfunction and deformities of the pelvis and the lower extremity.In the past, Harrington instrumentation was usually used to correct the curves,but the breakage of rods and dislodgement of hooks were encountered easily.With advancement of Segmental Spinal Instrumentation(SSI), Luque and C-D instrumentations were applied in clinic and has gotten better efficacy.More recently,great advances in biomechanics,and particularly in the pedicle screw system,have contributed to a three-dimensional correction for spinal deformities.Stiff fixation and better maintaining spinal contours have been widely applied to the treatment of idiopathic scoliosis and have obtained lots of successfulexperiences.But for neuromuscular scoliosis,especially for paralytic scoliosis,the literature is little.There are many controversy as to the treatment of PS still without finding an ideal operative procedure to now.The study concludes and analyzes 14 patients with the treatment of pedicle screw-rod system implants which were made of titanium alloy from May,2000 to November,2003,and discusses some questions of surgical management in detail.Materials and MethodsOf the 14 patients,seven were males,seven were females,with a mean age of 16.5 years(ranged from 11 to 26 years). 11 poliomyelitis patients and 3 myelodysplasia(MS) patients(2cases for second correction) had scoliosis of an average 85 Cobb angle( range,55-125 ),and an average tractive angle 51 (range,30-105 ).There were lumbar kyphosis in 9 patients with an average 32 curve(range, 15-42 ), lumbar lodorsis in 3 patients, non-available mesurement in 2 patients.The pelvic oblity was found in all patients with an average 24 angle(range,3-55 ).The dislocation of hip was found in 10 patients,the left were 4 cases,the right were 3 cases,the double were 3 cases.All patients followed deformities and/or decline of muscular forces of the lower extremity on different extents,such as: hip flexion and dislocation,flexion contracture of the knee,unequal leg length,talipes equinus,talipes calcaneus,talipes cavus,talipes varus,etc.All patients of MS had congenital vertebral anomalies,leg malfunction and disesthesia,but no gatism and other congenital organ abnormalities.Spinal fixation levels:the upper limit is commonly 1-2 vertebra above the upper terminal vertebra;the lower limit is the lower terminal vertebra or 1 vertebra under the lower terminal vertebra.Fixation devices: 11 sets of Scofix Instrumentations,3 sets of Chinese Great Wall Spinal System,1 set of Plate-Rod System of Scoliosis.Fusion segment:the shortest is 6 section,the longest is 15 section. Applied screw numbenthe most is 16,the fewest is 6.Technique of implanting pedicle screw:appearing anatomical sign of the vertebra in advance which need to be fixed,based on the different arrange of each vertebra,the location and director of inserted screw can be selected.The average blood loss was 1386 ml(500-2600ml)during the operation.Blood transfusion included autologous andallogeneic transfusion,the use of a cell-sav...
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