扩大蛋壳技术单纯后路切除青少年胸腰段半脊椎

Single posterior hemivertebrae resection by expanded eggshell technique in adolescent congenital scoliosis

目的通过回顾与随访,总结采用扩大蛋壳技术单纯后路半脊椎切除的技术要点,探讨如何避免并发症,评价单纯后路切除胸腰段半脊椎治疗青少年先天性脊柱侧后凸畸形的效果。方法采用单纯后路经椎弓根扩大蛋壳技术切除胸腰段半脊椎,共治疗28例青少年先天性脊柱侧后凸畸形。患者平均年龄14岁,其中男性19例,女性9例。12例半脊椎位于T12,10例半脊椎位于L1,6例半脊椎位于T11。Cobb角后凸角度平均75°,侧凸角度平均48°。所有病例均采用经椎弓根螺钉内固定系统矫形固定。结果平均手术时间3.7 h,失血量平均900m。l2例术中出现血气胸,其中1例经伤口引流愈合,另1例术后置胸腔管引流1周愈合。1例患者术中出现脑脊液漏,术后自然愈合。1例术中发生肋间神经损伤,术后出现一过性单侧肋间神经痛,未经任何治疗1周后消失;并发症发生率为14%。并发症主要发生在采用这一技术的早期阶段。所有病例未出现早期或晚期脊髓损伤症状和伤口感染。平均随访3.5年,所有病例均获得骨性融合。在最后随访时,Cobb角后凸角度平均19°,侧凸角度平均14°,所有病例躯干平衡。结论采用单纯后路经椎弓根扩大蛋壳技术切除胸腰段半脊椎操作性强,同前后路联合手术比较,大大缩短了手术时间,明显减轻了手术创伤,矫形效果好,无严重神经损伤或其它严重并发症。

Objective To summarize the technical points of singe posterior hemivertebrae resection by expanded eggshell technique, discuss how to avoid complication, evaluate the efficacy of the surgical technique in treating adolescent congenital kypoecoliosis. Methods Twenty-eight adolescent congenital kyphoscoliosis patients were treated by single posterior thoracolumbar hemivertebrae resection with expanded eggshell technique in our department. The patients were average 14 years old, 19 male and 9 female. Mean kyphotic Cobb angle was 75° and scoliotic Cobb angle was 48°. Twelve cases hemivertebra were located in T12, and 10 in Ll , 6 in T11. All patients received interfixation by transpedicular instrumentation. Results Mean operating time was 3.7 hours and bold loss was 900ml. Complication morbidity was 14%, which were occurred in the early stage of the technique application. Two patients occurred hemopneumothorax, one patient suffered cerebrospinal fluid leakage without any neurological problems and healed after drainage removed. Intercostal neuralgia occurred in one patient with auto- matic relieve. Early or late onset spinal cord injury symptoms and wound infection were not observed. All patients were followed up for average 3.5 years with all solid fusion were obtained. Cobb angle measurement was 19° of kyphosis and 14° of seoliosis. All patients gained trunk balance. Conclusion In correction of adolescent congenital kyphoscoliosis, single posterior hemivertebra resection by expanded eggshell technique is safe and effective without any severe neurological or other severe complication.