病 案
Case Study:L.R.’s Idiopathic Adolescent Scoliosis1)
L.R.，female，age 15
Main complaint:The patient had a posterior spinal fusion2)(PSF)for correction of idiopathic adolescent scoliosis in a pediatric orthopedic hospital in another state.L.R.is a gifted musician，and her favorite pastime is playing the piano，guitar，and other musical instruments.Lately she was experienced considerable back pain that she attributed to long hours at the piano or playing the guitar.It was time for her routine follow-up orthopedic visit，and now she present with a significant prominence of the right scapula and back pain in the mid-and lower back.
Examination:A history was taken and medical records were reviewed followed by a physical examination.The medical records indicated that the patient’s spinal curvature had been surgically corrected with the insertion of bilateral laminar3) and pedicle hooks4) and two 3/16-inch rods.A bone autograft was taken from L.R.’s right posterior superior ilium and applied along the lateral processes of T4 to L2 to complete the fusion.The physical examination was normal except for surgical scarring along the spine,a projecting right scapula,and asymmetry5) of the rib cage.During the history，L.R.denied numbness or tingling of the lower extremities，bowel or bladder problems，chest pain，or shortness of breath.The physician ordered a CT scan to determine if there had been continued growth on the anterior portion of the spine following the posterior fusion.
Clinical Course
The result of the CT scan of the upper thoracic spine showed a prominent rotatory scoliosis deformity of the right posterior thorax with acute angulation of the ribs.L.R.’s deformity is a common consequence of overcorrection of prior spinal fusion surgery,called crankshaft phenomenon6).
L.R.was referred to the chief spinal surgeon of a local pediatric orthopedic hospital for removal of the spinal instrumentation,posterior spinal osteotomies7) from T4 to L2，insertion of replacement hooks and rods，bilateral rib resections，autograft bone from the resected ribs,partial scapulectomy and possible bone allograft，and bilateral chest tube placement.The surgical plan was explained to her and her mother，and consent was obtained and signed.The surgical procedure and the potential benefits versus risks we discussed.L.R.and her parents stated that they fully understood and provided consent to proceed with the plan for surgery.
Follow-up
L.R.underwent a successful surgical procedure and was transferred to the pediatric ICU.Her postoperative course progressed well.She was discharged with orders for continued physical therapy and follow-up visits to the see the surgeon.L.R.had excellent compliance with all postoperative instuctions and was able to resume her musical activities sooner than expected.(https://www.daowen.com)
注释：
1）idiopathic adolescent scoliosis特发性青少年脊柱侧弯
2）posterior spinal fusion后侧脊柱融合术
3）laminar 层状的，板状的
4）pedicle hooks 椎弓根钩
5）asymmetry 不对称
6）crankshaft phenomenon 曲轴现象
7）posterior spinal osteotomies 后脊柱截骨术