青少年颈椎长节段严重后凸畸形手术方案的个体化选择

Individual choice of surgery program in long segment severe cervical kyphosis of the adolescents

目的探讨青少年颈椎长节段严重后凸畸形的颈椎前路手术、后路手术和前后路联合手术的治疗效果,进一步分析手术治疗此类疾病的个体化选择。方法回顾性分析我院2002年2月～2011年2月收治入院的青少年颈椎长节段严重后凸畸形患者18例的临床资料和手术治疗过程及治疗效果,术前、术后情况评价及手术方式选择的指标。结果根据对每例患者特点的具体分析采用针对性的手术入路。前方入路3例,后方入路3例,后方入路联合前方入路11例,一期前-后-前入路1例。后凸Cobb角由术前平均73°矫正至平均15°。随访3个月～6年,1例在融合固定的下端发生新的成角和节段性不稳,其余11例矫正度无明显丢失。3例瘫痪者均恢复正常神经功能。颈椎MRI检查表现高信号的18例患者中,没有发现颈椎后凸畸形和颈椎不稳,术后MRI信号变为正常。结论不同病因、不同畸形程度和不同继发性病理改变的青少年颈椎后凸畸形患者应采用合理的个体化手术治疗方案才能有效地矫正畸形和解除脊髓压迫。

Objective To investigate the effect of long segment of serious juvenile cervical kyphosis treated with anterior cervical spine surgery,posterior surgery and combined anterior,and analyze the individual surgical treatment of these diseases.Methods The clinical datas of 18 patients with long segment of severe cervical kyphosis in our hospital from February 2002 to February 2011 were analyzed retrospectively,including surgical treatment and the treatment effect,surgical evaluation before and after surgery,and selection of surgery methods.Results Targeted surgical approach were Based on the specific characteristics of each case.Anterior approach in 3 cases,back approach in 3 cases,the joint approach in 11 cases,one after a previous anterior in 1 case.Kyphosis Cobb angle before surgery by the average was 73°,corrected to an average of 15°.Followed up 3 months to 6 years,the integration of new fixed into the bottom corner and segmental instability occurred in 1 case,and the remaining 11 cases had no significant loss of correction,nerve function restore normal in 3 cases of paralysis.18 patients whose cervical spine MRI examination showed high signal found no cervical kyphosis and cervical instability postoperative and MRI signal changes normal.Conclusion The adolescent patients of cervical kyphosis with different causes,different degree of deformity and different deformity secondary pathological changes should be given reasonable individualized surgical treatment in order to effectively correct the deformity and relieve spinal cord compression.