后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸

Severe rigid kyphotic scoliosis treated with posterior spinal osteotomy

目的：评价应用后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸的效果。方法：回顾性分析北京大学第一医院骨科自2005年3月至2006年9月应用后路脊柱截骨矫形治疗重度脊柱僵硬后凸型侧凸11例（平均年龄11.2岁）,其中神经纤维瘤病3例,先天性脊柱侧弯5例,脊髓灰质炎1例,特发性脊柱侧凸2例。11例患者的Bending像脊柱活动度均小于25%。平均随访时间1.3年（0.5～2年）。结果：术中1节段后柱楔形截骨3例,2节段后柱楔形截骨2例,3节段后柱楔形截骨2例,经椎弓根截骨2例,椎体切除＋后柱切除2例。术前后凸畸形平均108°（87°～135°）,侧凸畸形平均97°（65°～135°）,术后后凸畸形平均矫正至49°（改善率55%）,侧凸平均矫正至37°（改善率66%）。术后身高平均增加4.7cm。11例矫形手术无神经系统并发症发生。结论：应用后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸是一种较为有效的手术方法。

Objective： To evaluate the effect of severe rigid kyphotic scoliosis treated with posterior spinal osteotomy Methods： A total of 11 cases（average 11.2 years） of severe rigid kyphotic scoliosis treated with posterior spinal osteotomy from Mar.2005 to Sept. 2006 were retrospective. Of those cases, 3 were of neurofibromatosis, 5 of congenital scoliosis, 1 of poliomyelitis and 2of idiopathic scoliosis. The flexibility of all patients was less than 25%. They had an average follow-up period of 1.3 years （0.5-2 years） Results： There were 3 cases of one segment posterior wedge osteotomy, 2 of two segment posterior wedge osteotomy and 2 of three segment wedge osteotomy. Transpedicular osteotomy was performed in 2 cases, and the last 2 cases encountered vertebral resection and posterior column removed. The average kyphotic angle was 108 degrees （ranging from 87 to 135 degrees） and the average scoliosis angle was 97 degrees （ranging from 65 to 135 degrees） before operation. After operation the average kephotic angle was corrected to 49 degrees （the correction rate was 55%） and the average scoliosis angle was corrected to 37 degrees（the correction rate was 66%） . The height rose up by an average of 4.7 cm. No neurological complication happened in all the 11 cases. Conclusion： It is an effective method that severe rigid kyphotic spinal scoliosis is treated with posterior osteotomy.