前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸

Combined Mini-open Anterior Apical Vertebral Excision and Posterior Correction for Severe and Rigid Scoliosis

目的探讨前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸的可行性及疗效。方法 2009年7月-2010年9月,采用前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸18例。其中男9例,女9例,年龄10～24岁,平均14.5岁。其中15例特发性脊柱侧凸(Lenke 2型6例,Lenke 3型1例,Lenke 4型8例),2例脊髓空洞合并脊柱侧凸,1例Chiari畸形合并脊柱侧凸。术前剃刀背高度(6.8±2.3)cm,主胸弯Cobb角(99.6±10.0)°,主胸弯顶椎偏距(7.3±1.3)cm。结果前路手术切口10～13 cm,平均(11.4±1.0)cm;前路手术时间170～300 min,平均(215.3±36.8)min;失血量300～1 300 mL,平均(662.5±274.8)mL。所有患者随访25～39个月,平均30.7个月。末次随访时,剃刀背高度(1.0±0.6)cm,矫正率86.7%;主胸弯Cobb角(31.4±11.4)°,矫正率68.7%;主胸弯顶椎偏距(2.2±0.9)cm,矫正率69.6%。上胸弯、胸腰弯/腰弯的Cobb角及顶椎偏距亦明显矫正,冠状面及矢状面平衡与术前相比,差异无统计学意义(P>0.05)。未发生神经系统并发症,1例患者在前路手术后入ICU行呼吸支持治疗12 h,1例患者出现椎弓根螺钉穿透椎弓根上壁,2例患者出现钛网位置不佳,随访未见钛网位置改变。结论采用前路小切口顶椎切除联合后路矫形治疗重度僵硬性脊柱侧凸安全可行,矫形效果满意。

Objective To discuss the feasibility and treatment effect of combined mini-open anterior apical vertebral excision and posterior correction for severe and rigid scoliosis.Methods From July 2009 to September 2010,18 patients with severe and rigid scoliosis were treated with combined mini-open anterior apical vertebral excision and posterior correction.There were 9 males and 9 females with an average age of 14.5 years（ranged from 10 to 24 years）.There were 15 idiopathic scoliosis（6 Lenke 2 curves,1 Lenke 3 curves,8 Lenke 4 curves）,1 congenital scoliosis,2 syringomyelias with scoliosis,and 1 Chiari抯 deformities with scoliosis.Before the operation,the height of razor back,the Cobb angle and the apical vertebral translation of main thoracic curve was（6.8 ？2.3） cm,（99.6 ？10.0）？and（7.3 ？1.3） cm,respectively.Results The length of anterior incision averaged（11.4 ？1.0） cm（ranged from 10 to 13 cm）.The operating time and blood loss of anterior surgery averaged（215.3 ？36.8） min（ranged from 170 to 300 min）,and（662.5 ？274.8） mL（ranged from 300 to 1 300 mL）,respectively.All patients were followed up for 25 to 39 months,averaged 30.7 months.At the final follow-up,the height of razor back was（1.0 ？0.6） cm with a correction rate of 86.7%.The Cobb angle of main thoracic curve was（31.4 ？11.4）？with a correction rate of 68.7%.The apical vertebral translation of main thoracic curve was（2.2 ？0.9） cm with a correction rate of 69.6%.The Cobb angles and apical vertebral translations of proximal thoracic curve and thoracolumbar/lumbar curve had been corrected satisfactorily.The coronal imbalance and sagittal imbalance had no significant difference with the preoperative values.No neurologic compromise happened.One patient required ventilator support for 12 hours after anterior surgery.Malposition of one pedicle screw,which showed as superior cortical wall violation on lateral radiograph,was found in one patient.Malposition of titanium mesh cage happened to 2 patients.No position change of cage was found during the follow up.Conclusions It is safe and feasible to treat severe and rigid scoliosis by mini-open anterior apical vertebral excision and posterior correction.And good results can be achieved.