一期胸腰椎两处截骨治疗重度先天性脊柱侧凸并脊髓拴系综合征

One-stage thoracolumbar double osteotomy for severe congenital scoliosis with tethered cord syndrome

目的：评价经后路一期胸腰椎两处截骨治疗重度先天性脊柱侧凸合并脊髓拴系综合征的早期临床效果：方法：2008年6月～2009年2月，采用经后路一期胸腰椎两处截骨短缩脊柱治疗重度先天性脊柱侧凸合并脊髓拴系综合征3例均为女性，年龄分别为15岁、17岁和17岁，术前冠状位侧凸Cobb角81°、123°、141°，侧凸柔切性23．5％、18．7％、0．7％冠状f矗偏移距离6．9cm、1．6cm、1.8cm-2例合并矢状位畸形，骨凸Cobb角52°、46°椎体分节不全2例，半椎体畸形1例；2例合并脊髓纵裂。3例均有下肢无力、步态异常及膀胱功能障碍．2例有腰痛，1例双足疼痛。结果：手术时间平均8．1h，术中出血量3200～4200ml，平均3733ml。术后侧凸Cobb角分别为7°、27°、37°．矫正率91．4％、78％、73．7％；冠状位偏移距离0．2cm、0．8cm、0．3cm．矫正率97．1％、50％、83．3％2例骨凸Cobb角22°、25°，矫止率57．7％、45．7％分别随访19、15、13个月，末次随访时侧凸Cobb角分别为10°、28°、39°，矫正率为88．7％、77.2％、72．3％；冠状化偏移距离0．3cm、0．9cm、0．4cm，矫正率为95．6％、43．7％、77．7％.2例后凸Cobb角24°、26°所有患者植骨愈合良好，内固定无断裂及松动。术后所有患者脊髓拴系症状逐渐改善，禾次随访时2例症状完全消失。结论：后路一期胸腰椎两处截骨不仅能较好矫正重度先天性脊柱侧凸畸形，并可同时减轻脊髓拴系张力，缓解拴系综合征，近期疗效良好。

Objective：To evaluate the short-term efficacy of one-stage thoracolumbar double osteotomy via posterior approach for severe congenital scoliosis associated with tethered cord syndrome.Method：From June 2008 to February 2009,3 patients with severe congenital scoliosis associated with tethered cord syndrome were treated with one-stage thoracolumbar double osteotomy.All the patients were female at the age of 15,17 and 17 years oht,respectively.Their pre-operative scoliosis cobb angle was 81°,123° and 141° respectively.The spinal scoliosis flexibility was 23.5%,18.7% and 0.7%.The vertical distance between C7 and the center sacral line was 6.9cm, 1.6cm and 1.8cm.2 of them had kyphosis with Cobb angle 52° and 46° before operation.Among the 3 patients,2 patients were associated with unilate unsegmented bar deformity,2 with diastematopyella,and 1 with hemivertebrae.Also,2 patients sustained progressive low back pain,l bilateral foot pain,and all the patients had lower limb weakness,associated with gait impairment and urinary dysfunction.Result：The average surgery tittle was 8.1 hours with average blood loss of 3733ml（3200-4200ml）.At immediate postoperative assessment,the scoliosis was 7~ ,27° and 37° .showing 91.4% ,78% and 73.7% scoliosis correction.The coronal imbalance was 0.2cm,0.8cm and 0.3cm showing 97.1%,50% and 83.3% correction respectively.As for the 2 patients with kyphotie deformity cobb angle 22° and 25° ,the kyphotic deformity correction was 57.7% and 45.7%.Afl patients were followed up for 19,15 and 13 months. At the most recent follow-up,the Cobb angle was 10° ,28° and 39° ,showing 88.7% ,77.2% and 72.3% scoliosis correction,respectively.The vertical distance between C7 and the center sacral line was 0.3cm,0.9cm and 0.4cm,showing 95.6% ,43.7% and 77.7% correction.Moreover,the kyphosis cobb angle was 24° and 26°.Bony fussion was achieved in all pa-there were no internal fixation failures or no significant correction loss.The patients＇ tethered cord have been improved gradually after surgery without any symptoms in the recent follow-up.Conclusurgical procedure is reliable in correcting severe deformity as well as relieving tethered cord syndromes.