改良脊柱截骨治疗重度驼背畸形32例随访观察

Osteotomy of spine multisegments and pedicle screw internal fixation for corrating serious kyphosis

[目的]研究重度驼背畸形安全有效的矫正和内固定方法,探索其早、晚期严重并发症的预防。[方法]后路横形多节段后、中柱截骨经椎弓根钉棒系统长节段三维内固定。[结果]最大矫正64°,最少矫正50,°站立身高最多增加30 cm,最少增加22 cm,无死亡、截瘫及不完全瘫。2例术后并发肠系膜上动脉综合征者经及时有效处理,相应症状5 d内消失。平均随访5年8个月,全部病例脊柱长期稳定性良好,矫正度未见明显丢失,外观畸形明显改善,能平卧,双目能平视前方,生活质量大大提高。[结论]改良脊柱后路截骨经椎弓根钉棒系统三维内固定,增加了脊柱截骨后的稳定和融合点,加强了内固定钉棒两端的集体抓握力,对脊柱的良好融合、长期稳定和矫正度数少丢失或不丢失起到重要作用,是治疗重度驼背畸形的一种安全可靠的方法。

[ Objective] To explore a safe and resulfful orthopedic and fixative way for corrating serious kyphosis. To study the fatalness and provent complication. [Method] All cases were treated with muhisegments osteotomy of central and posteior spine columns and pedicle long segment fixation from posterior. [ Result] The corraction angle was 50° -64° and the body heigh increased 20 -30 cm. There was no death, paraplegia and incomplete paralysis. Two patients who had superior mesenteric artery syndrom after operation were cured well within five days＇ treating. Postoperative follow up averaged 5 years and 8 months. The spine stability was good and there was no loss of corraction angle. The appearance is also improved well. All cases could lie down and look forward. The quality of life was better than before. [ Conclusion ] Modified posterior osteotomy of spine and pedicle screw internal fixation can increase stability and fusion of spine, enhance the concentrative grab force of screw. It is effective on good fusion, long stability and little or no loss of corraction angle. So it is a satisfactory and reliable technique for corrating serious kyphosis.