后路全脊椎切除牵引后伸交叉棒加压矫治重度高位胸椎角状后凸

Posterior en bloc corpectomy followed by traction-extension and crossing rods compression for severe upper-thoracic spine angular kyphosis

目的：评价后路全脊椎切除牵引后伸交叉棒加压矫形治疗重度高位胸椎角状后凸畸形的安全性和临床初步效果。方法：2005年3月~2008年11月采用后路全脊椎切除牵引后伸交叉棒加压矫形治疗重度高位胸椎角状后凸畸形患者10例,男5例,女5例,年龄4~44岁,平均17.7岁;其中先天性椎体形成不良7例,陈旧性胸腰椎结核1例,神经纤维瘤病1例,陈旧性T3骨折1例。角状后凸节段：T3、T4和T5各3例,T6 1例。术前矢状面角状后凸Cobb角73°～155°,平均98.9°;腰前凸角24°～81°,平均48.2°;矢状位偏移距离-5.0～5.5cm。7例合并侧凸畸形,冠状面侧凸Cobb角11°～110°,平均56.0°;冠状位偏移距离0.2～6.5cm,平均3.24cm。2例先天性椎体形成不良和1例结核患者合并神经损害,Frankel分级C级2例,D级1例。结果：均顺利完成手术,手术时间为7.9～14.7h,平均10.6h;术中出血1400～5600ml,平均3750ml。切除椎体1～2个,平均1.5个。脊髓短缩1.6～2.6cm,平均2.1cm。融合固定5～12个椎体,平均8.7个。术后矢状面后凸Cobb角矫正至平均19.0°,矫正率80.3%;腰前凸角矫正至平均34.3°,矫正率33.5%;冠状面Cobb角矫正至平均12.0°,矫正率79.9%;躯干矢状位偏移距离矫正至-0.5~0.5cm,矫正率90.4%;冠状位偏移距离矫正至平均0.51cm,矫正率89.5%。术前2例Frankel C级和1例D级神经损害者,术后恢复到E级。随访25～69个月,平均38.2个月,所有患者获得良好的骨性愈合,无脊髓损伤和矫正度的显著丢失。结论：后路全脊椎切除牵引后伸交叉棒加压矫治重度高位胸椎角状后凸畸形可提供安全有效的矫正力并能获得满意的疗效。

Objective：To investigate the safety and preliminary clinical outcome of traction-extension and crossing rods compression correction after posterior en bloc corpectomy for upper-thoracic angular kyphosis.Method：From March 2005 to November 2008,10 patients with upper-thoracic angular kyphosis underwent traction-extension and crossing rods compression correction after posterior en bloc corpectomy.There were 5 males and 5 females with an average age of 17.7 years（range,4-44 years）.The pathogenesis included congenital vertebra dysplasia deformity in 7 cases,old tuberculosis in 1 case,old T3 fracture in 1 case and neurofibromatosis in 1 case.The apex vertebra was sited in T3,T4,T5 in 3 patients respectively and T6 in 1 patient.The preoperative angular kyphotic Cobb angle was 73°-155°,averaging 98.9°.The lumbar lordotic Cobb angle was 24°-81°,averaging 48.2°.The sagital trunk shift was-5.0-5.5cm.7 patients were complicated with scoliosis,whose coronal Cobb angle was 11°-110°（averaging,56.0°）,and the coronal trunk shift was 0.2-6.5cm,averaging 3.24cm.For 2 cases with vertebra dysplasia and 1 case with old tuberculos presented with neurologic deficits,there were 2 Frankel C and 1 Frankel D.Result：All operations were performed successfully.The average surgical time was 10.6 hours（range,7.9-14.7h）;the average blood loss was 3750ml（range,1400-5600ml）;the average spinal cord shortening was 2.1cm（range,1.6-2.6cm）.The average number of vertebra bodies resected was 1.5,ranging from 1 to 2.The average fusion segments were 8.7 ranging from 5 to 12 segments.All patients had an average sagittal Cobb angle correction rate of 80.3% and an average lumbar lordosis correction rate of 33.5%.The average coronal Cobb angle correction rate was 79.9%,and the average sagittal trunk shift correction rate was 90.4%.The average coronal imbalance correction rate was 89.5%.All patients were followed up for 25-69 months（average,38.2 months）.The patients with neurologic deficits recovered to Frankel E.All patients got good bony fusion without neurological deficit or significant loss of correction.Conclusion：Traction-extension and crossing rods compression can provide reliable and effective correction force for severe upper-thoracic spine angular kyphosis.