改良型经椎弓根截骨治疗小儿胸腰段治愈型结核伴后凸畸形

Modified pedicle subtraction osteotomies(mPSO) for thoracolumbar post- tubercular kyphosis in pediatric patients

[目的]通过临床病例回顾性研究,对改良型经椎弓根截骨治疗伴后凸畸形的小儿胸腰段治愈型结核的疗效进行系统评估。[方法]回顾分析2008年1月-2012年7月间进行手术治疗的36例小儿胸腰段治愈型结核伴后凸畸形的患者,通过对比C7铅垂线与S1后上角距离,胸腰段Cobb角、VAS及ODI评分,评价患者畸形矫形效果及生活质量,评估改良型经椎弓根截骨治疗小儿胸腰段治愈型结核伴后凸畸形的疗效。[结果]本组36例患者均得到随访,随访时间18-56个月,平均41个月。所有患儿伤口均一期愈合。无神经功能损伤等严重并发症。C7铅垂线与S1后上角距离术前为（105.0±11.40）mm,术后纠正为（38.0±5.91）mm,胸腰段Cobb角由术前（60.60±3.70）°缩小为术后的（19.7±2.2）°。患者畸形得到较好的矫正,重建了矢状位平衡。VAS及ODI评分术前术后对比差异均有统计学意义（P〈0.05）,患者生活质量得到明显改善。[结论]采用改良型经椎弓根截骨术（MPSO）治疗小儿胸腰段治愈型结核伴后凸畸形矫形效果明显,手术时间短,手术风险相对较小,后凸矫果好,术后并发症少,融合率高,患儿满意度高。

[ Objective ] To prove the results with the treatment of pediatric with kyphosis in healed thoracolumbar tubercu- losis undergoing modified pedicle subtraction osteotomy （MPSO） . [ Methods] From January 2008 to July 2012, thirty -six pediatric with kyphosis in healed stages of spinal tuberculosis, all with kyphotic deformity of the spine in healed stages of TB un- derwent modified pedicle subtraction osteotomy （MPSO） . The mean follow -up was 41 months （rangel8 -56 months） . The kyphotic angle ranged from 51° to 79° before operation, 60. 6° in average. The horizontal distance between the C7 and S1, tho- racolumbar kyphosis, thoracic kyphosis and lumbar lordosis was measured from photographs of the patients before and after oper- ation. Functional measurement was evaluated utilizing VAS and ODI. [ Results ] All incisions were healed perfectly. No neuro- vascular injury was noted. Kyphotic Cobb angle was 60. 6°and 19. 7°respectively before and after operation, with average correc- tion 40. 9°. The horizontal distance between the C7 and SI was （105.0 ± 11.40） mm and （38.0 ± 5.91 ）mm respectively be- fore and after operation. VAS was （7. 2 ± 1.1 ） preoperatively and （3.2 ±0. 7） after operation. ODI score was （39. 5 ±2. 3） preoperatively, （16. 8 ± 3.3 ） postoperatively, respectively. All patients received good bone healing, no significant loss of cor- rection angle was found. [ Conclusion] Modified pedicle subtraction osteotomy （MPSO） is effective for kyphosis in pediatric who are with healed stages of thoracolumbar tuberculosis.