多平面脊椎截骨矫正脊柱后凸畸形并发脊椎滑脱（附6例报告）

SpondylolisthesisasaComplicationofMultilevelOsteotomyoftheSpineintheTreatmentofKyphosis:AReportof6Cases

本文介绍我院１９８５年５月～１９９３年５月应用多平面脊椎截骨矫正脊柱后凸畸形３７６例中６例脊椎滑脱，其中两例瘫痪。滑脱多发生在畸形重、截骨矫正度数大病例。强大挛缩腹肌及椎旁软组织牵拉力；截骨面不稳；内固定不牢及松脱是发生椎体滑脱的主要原因。为予防其发生，我们体会是（１）多平面截骨中单一平面矫正最好不超过３０°，两平面不超过６０°，过多残留畸形可二次手术。（２）注意截骨面与椎体垂直、左右对称，保留椎前１／４骨质，增强合拢骨面稳定。（３）强调妥善保护下背部逐渐缓慢加压合拢法。（４）采用坚强有效内固定，遇有滑移倾向者可采用椎板下钢丝鲁氏法或弓根钉装置等固定。（５）适当切除截骨面上下椎板内壁，扩大椎管容积，以防滑脱脊髓受压。

FromMay1985toMay1993,376casesofKyphosisweretreatedbymulti-levelos-teotomyofthespine.Amongthem,6werecomplicatedwithspondylolisthesisandtwodevelopedpara-plegia.Spondylolisthesismostcommonlyoccurredincaseswithseveredeformityandwithgreatdegreeofoperativecorrection.Themaincausesofspondylolisthesiswere;1.thepowerfulcontractionforcc;2.instabilityattheosteotomyplane;and3.unsteadyevenloosenedinternalfixation.Inordertopreventspondylolisthesis,thefolowingprincpliesshouldbeobserved:1.thedegreeofcorectionateachsinglelevelshouldnotexceed30degreesandthetotalamountattwolevelsnotex-ceed60degrees.Theresidualdeformity,ifthereisanyleft,istobecorrectedatasecondseting;2.Theosteotomyplaneshouldbeperpendiculartothevertebralbody,withitsanteriorone-fourthleftin-tactinordertomaintainmorestabilityattheosteotomysurfaceswhentheyaremanipulatedintoopposi-tion;3.Manipulatingforceatthebackshouldbemildandslowlyappliedunderperfectprotection;4.Rigidandefectiveinternalfixationshouldbeused.Ifthereisanydangerofslipping,Luquerodswithsublaminalwireorpediclenailfixationmaybeused;5.Suitableamountoftheintrenalwaloftheadja-centlaminaebothaboveandbelowtheosteotomysiteisresectedinordertoexpandthespinalcanalandpreventcordcompression.