一期后路全椎截骨矫形治疗脊柱侧后凸畸形

Single-stage posterior total vertebral osteotomy for correction of kyphoscoliosis

目的评价一期后路全椎截骨矫形治疗脊柱侧后凸畸形手术的安全性及其临床疗效。方法脊柱侧后凸畸形患者21例，其中先天性脊柱侧后凸畸形17例，特发性脊柱侧后凸畸形4例。畸形主弯位于胸腰段者（第10胸椎～第2腰椎）14例，腰段者（第3～5腰椎）4例，胸段者（第1—9胸椎）3例。21例患者均行一期后方入路全椎截骨矫形椎弓根钉系统内固定、植骨融合术，比较其手术前后及末次随访脊柱全长正、侧位x线片，测量脊柱侧弯、后凸Cobb角及矢状面和冠状面平衡矫正情况。结果所有患者均顺利完成手术，手术时间215～515min，平均351．4min；失血量750～2950ml，平均1450ml。平均随访18．9个月（12～24个月），平均脊柱侧弯矫正率为69．1％，后凸矫正率为66．7％。所有患者均获骨性愈合，未发生内固定失败、脊髓神经根受损及感染等并发症，躯干失代偿状况均得到矫正。结论一期后路全椎截骨矫形椎弓根钉系统内固定术矫治脊柱侧后凸畸形安全有效，具有融合率高、并发症少、手术时间短等优点。但手术过程对术者技术熟练程度要求较高，并伴有一定的并发症风险。

Objective To evaluate the surgical total vertebral osteotomy for correction Of kyphoscoliosis. safety and clinical effect of single-stage posterior Methods Twenty-one patients with kyphoscoliosis, 17 cases were congenital kyphoscoliosis and 4 cases were idiopathic kyphoscoliosis. They were treated with single-stage posterior total vertebral osteotomy for correction. Lateral side X-ray photograph of patients pre- and postoperative were compared. Scoliosis, Cobb angle, the spinal corrective angle in sagittal and coronal pre- and postoperative were measured. Results The operation was completed smoothly in all the 21 patients. Mean operating time was 351 minutes （range 215 -515 min）, and the average blood loss was 1450 ml （range 750 -2950 ml）. The followed up of all patients was 18.9 months （range 12 -24 months）. Deformity correction was 69. 1% in the coronal plane and 66.7% in the sagittal plane. All patients got good trunk balance with no decompensation. Neurologic complication, nonunion of bone, infection, loosening or breakage of the internal fixator were not found. Conclusions Single-stage posterior total vertebral osteotomy for correction of kyphoscoliosis is effective and safe, and have a advantages of high fusion rate, less complication and short operation time. However, it is a technically demanding and exhausting procedure with some potential risks of complications.