先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形的后路松解楔形截骨矫治

The treatment of orthodontics of posterior mobilization cuneiform osteotomy in congenital half thoracolumbar vertebral body combined with severe rigid spinal kyphoscoliosis deformity

目的探讨先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形患者采用经后路松解楔形截骨治疗的安全性和临床初步效果,并探讨其融合固定节段(LIV)的选择。方法选择我院2006年7月～2011年10月收治的先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形患者10例临床资料,均行经后路松解楔形截骨矫形手术,以触及椎(touched vertebrae,TV)(指站立前后位像上被骶正中线触及的最近端椎体)作为融合固定下端椎。结果本组10例患者均顺利完成手术。平均松解3.0个椎间隙;手术时间4.5～9.4 h,平均6.3 h;术中出血量680～10 000 mL,平均985 mL;术后侧凸Cobb角6°～32°,平均18.7°,平均矫正率为27.2%;后凸Cobb角-8°～22°,平均8.3°,平均矫正率为88.6%;C7铅垂线与骶正中线距离0.1～2.3 cm,平均0.6 cm,冠状位平衡平均矫正率为78.1%。随访14～35个月,平均23.4个月,末次随访侧凸Cobb角8°～57°,平均29.7°,丢失率为7.3%;后凸Cobb角22°～38°,平均29.9°,丢失率为7.7%。结论经后路松解楔形截骨矫治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形安全有效,选择TV作为LIV可以减少融合节段。

Objective To investigate the safety and clinical preliminary effect of the orthodontics of congenital half thoracolumbar vertebral body combined with severe rigid spinal kyphoscoliosis deformity treated by posterior mobilization cuneiform osteotomy,and to discuss the segment choice of fusion and instrumentation.Methods The clinical data of 10 cases with the orthodontics of congenital half thoracolumbar vertebral body combined with severe rigid spinal kyphoscoliosis deformity in our hospital from July 2006 to October 2011 were collected.All cases were treated by posterior mobilization cuneiform osteotomy with the touched vertebrae（TV） for the fusion and instrumentation lower end vertebrae.Results All the 10 patients were completed the operation successfully,and 3.0 intervertebral spaces were released for average.Operation time was from 4.5 to 9.4 hours with 6.3 hours for average;the intraoperative bleeding was between 680 to 10 000 mL,for 985 mL on average.The lateral protruding Cobb angles were between 6° to 32°,18.7° on average,the average correct rate was 27.2%;while kyphotic Cobb angles were from 8° to 22°,8.3° for average,average correction rate was 88.6%.The distance from C7 plumb line to the midline of sacrum was 0.1～2.3 cm,which was 0.6 cm on average.The average correction rate of coronal balance was 78.1%.All had been followed up for 14～35 months,The lateral protruding Cobb angle was 29.7° on average at the last follow-up and the loss rate was 7.3%.The kyphotic Cobb angle was between 22° to 38° with 29.9° on average at the last follow-up,the loss rate was 7.7%.Conclusion It is safe and effective for the orthodontics of congenital half thoracolumbar vertebral body combined with severe rigid spinal kyphoscoliosis deformity treated by posterior mobilization cuneiform osteotomy.It can reduce fusion segments by choosing TV as lowest instrumented vertebrae.