经后路松解胸椎间隙在重度僵硬性脊柱侧凸矫正术中的应用

Application of Treating Severe and Rigid Scoliosis with Posterior Thoracic Intervertebral Space Releases

目的：评价经后路胸膜外松解胸椎间隙联合顶椎区脊椎楔形截骨及椎弓根钉内固定术治疗重度僵硬性脊柱侧凸的安全性和临床效果.方法：采用经后路胸膜外松解凸侧胸椎间隙联合顶椎区脊椎楔形截骨及椎弓根螺钉内固定术治疗重度僵硬型侧凸患者28例.其中特发性19例,先天性脊柱侧后凸6例,神经纤维瘤病、神经肌肉型、瘢痕型各1例.术前侧凸Cobb角平均103°.平均松解椎间隙5.2个,楔形截骨平均2.2个椎体.结果：全组无一例脊髓损伤.1例术中发生血气胸,1例术后第4天并发肠系膜上动脉综合症,经对症处理,均于术后2周痊愈 术后3月T11-12局部感染1例,行病灶清除术后3周痊愈.术后即刻测量侧凸Cobb角平均27.7°,矫正率平均73%.随访19.2个月,所有患者获得良好的骨质愈合,内固定无断裂及松动,矫正无明显丢失.躯干平衡良好.结论：经后路胸膜外松解胸椎间隙联合顶椎区脊椎楔形截骨与胸廓成形及后路脊柱矫形术使用同一个手术切口.该术式创伤小,对心肺干扰小,降低了手术风险,有效改善了脊柱柔韧性,提高了矫正率.

Objective ：To evaluate the efficacy and safety of treating severe and rigid seoliosis with posterior thoracic intervertebral space releases. Methods：Twenty-eight ,patients with severe rigid scoliosis were surgically treated with posterior extrapleural thoracic intervertebral space solution, wedge osteotomy on the apex vertebra and trans-pedicular fixation combined with correction and fusion. Among them, 19 patients were idiopathic scoliosis, 6 patients with congenital scoliosis, one patient with neurofibromatosis seoliosis, one with neu- romuscular scoliosis and one with scar scoliosis. The average angle of preoperative scoliosis cobb was 103°（ 80° - 139°）. An average of 5.2 thoracic vertebras was released and 2.2 vertebras were resected by wedge. Re- suits：There was no major complication of neurological injury. One patient had rupture of pleura in operation, one had superior mesenteric artery syndrome on the 4th postoperative day. The two patients recovered complete- ly 2 weeks after operation. Moreover, one patient infected in the 3rd postoperative month recovered completely 3 weeks after being performed debridement. At the immediate postoperative assessment, the scoliosis was 27.7° （8°- 46°） , showing a 73% scoliosis correction. All the patients were followed up for an average of 19.2 months,and they achieved bony fussion with an excellent balanced trunk. Furthermore, there were no internal fixation failures or significant correction loss. Conclusions ： The advantages of the posterior approach by an extra- pleural releases thoracic vertebra lie in fewer tramnas of operation and less disturbance for heart and lung. What＇ s more, it reduces the risk in surgeries, improves spinal flexibility and increases the correction rate of the deformity.