PVCR技术治疗重度胸腰椎角状后凸畸形疗效观察

Posterior vertebral column resection for the treatment of severe angular thoracolumbar kyphosis

目的探讨一期后路全脊柱切除联合前方钛网支撑治疗重度胸腰椎角状后凸畸形的策略及安全性。方法 2007-01-2012-10,采用后路全脊椎切除（PVCR）联合前方钛网支撑手术治疗18例胸腰椎角状后凸畸形患者,术前、术后和末次随访时分别测量患者后凸Cobb’s角,并评估神经功能ASIA分级。结果本组患者手术均顺利,手术时间250~460 min,平均318 min;术中出血量1600~2600 ml,平均2120 ml,术后Cobb’s角平均10~21°,平均16.6°,矫正率77.8%,术中及术后无脊髓及神经根损伤、大血管及脏器损伤等并发症发生,平均随访时间16.8月,复查X线,后凸矫形无丢失,内固定及椎间植骨融合钛网无移位。结论一期后路全脊柱切除联合前方钛网支撑治疗重度胸腰椎角状后凸畸形是较可靠的手术技术。

Objective To report on the technique and results of posterior vertebral column resection（ PVCR） for severe angular thoracolumbar kyphosis. Methods From January 2007 to October 2012,17 patients with severe thoracolumbar kyphosis underwent posterior vertebral column resection（ PVCR） in our institute. They were 13 males and 5 females, with an average age of 26.4years old（ range,18 to 39years）. The preoperative Cobb angle was 64°-105°In these cases,kyphotic Cobb angle and ASIA grade were measured before operation, after operation and at final follow-up.Results All operations were performed successfully. The operation time ranged from 250 to 460min（ average,318min）; blood loss during the operation ranged from 1600 to 2600ml（ average,2120ml）,The postoperative kyphosis ranged from 10° to 21°（ average,16.6°）,which showed significant difference（ P〈0.01）. The average kyphosis correction rate was 77.8%. The follow-up ranged from 13 to 34 months（ average,16.8months） and kyphosis at final follow-up ranged from 10° to 23°（ average,17.5°）. Among the 2 patients with preoperative ASIA grade D,5 cases improved to grade E, the kyphosis improved and the local back pain relieved very well. Conclusion Posterior vertebral column resection is an effective and safe way to treat severe thoracolumbar kyphosis