重度僵硬后凸型脊柱侧凸畸形的手术治疗

Surgical treatment of severe rigid kyphotic scoliosis

目的探讨应用脊柱后路截骨矫形治疗重度僵硬性脊柱侧后凸畸形的治疗效果及临床应用价值。方法 2007年5月至2008年6月采用经后凸顶椎椎弓根Ⅴ形截骨,凸侧采用悬臂梁压棒技术治疗16例重度僵硬性脊柱侧后凸畸形患者,男12例,女4例,年龄14～22岁,平均17.4岁。先天性脊柱侧后凸11例,特发性脊柱侧后凸5例。截骨部位均位于胸椎。结果平均手术时间(226±32)min,术中出血量(1360±265) ml,平均随访28个月(24～36月),术前主弯侧凸Cobb角83°±11.7°(75°～106°),后凸角91°±13.2°(82°～102°),术前C7铅垂线距骶中线距离(1.45±0.26)cm;术后侧凸Cobb角矫正至27.4°±11°(矫正率67%);后凸Cobb角25.5°±9.5°(矫正率72%)。C7铅垂线距骶中线距离(0.48±0.13) cm。无神经系统并发症发生。结论经后凸顶椎椎弓根V形截骨,凸侧采用悬臂梁压棒技术治疗重度僵硬性脊柱侧后凸畸形是一种安全、可靠的方法,矫形效果满意。

Objective To evaluate the efficacy and clinical value of severe rigid kyphotic scoliosis treated with posterior spinal osteotomy.Methods From May 2007 to June 2008,a total of 16 consecutive patients（average 17.4 years） of severe rigid kyphotic scoliosis were treated with posterior transpedicular wedge osteotomy at the apex of the deformity and cantilever bending technique on the convex side.There were 12 male and 4 female with an average age of 17.4 years（14 -22）.Of those cases 11 were of congenital scoliosis,5 of idiopathic scoliosis.The osteotomy were all in the thoracic. Results The average operation time was 226±32min and the mean total blood loss was 1360±265ml.They had an average follow-up period of 28 months（24-36m）.The average preoperative major Cobb angle was 83°±11.7°＂（75°±- 106°）,The average kyphotic angle was 91°±13.2°（82°-102°） before operation.After operation the average scoliosis angle was corrected to 27.4°±11°degrees（67%correction） and the average kyphotic angle was corrected to 25.5°±9.5°degrees（72%correction）.The mean preoperative coronal imbalance of 1.45±0.26 cm was improved to 0.48±0.13 cm after operation.No neurological complication happened in all the 16 cases.Conclusion It is an effective and safe method that severe rigid kyphotic scoliosis treated with posterior transpedicular wedge osteotomy at the apex of the de- formity and cantilever bending technique on the convex side.