一期后路楔形截骨联合顶椎区广泛松解治疗严重脊柱侧后凸畸形

One-stage posterior vertebral column resection combined with release of the apical vertebrae in the management of the severe rigid severe kyphoscoliosis

目的探讨一期后路楔形截骨联合顶椎区广泛松解治疗严重脊柱侧后凸畸形的安全性及早期疗效。方法自2007年2月-2015年1月对26例僵硬型脊柱侧后凸采用一期后路楔形截骨联合顶椎区广泛松解钉棒系统矫形内固定矫形。男14例,女12例;年龄15-45岁,平均25.4岁。其中单纯半椎体10例,多发半椎体4例,成人特发性脊柱侧凸8例,脊髓空洞并脊柱侧凸3例,脊柱结核并侧后凸畸形1例。术前脊柱侧凸Cobb’s角74°-118°,平均83.2°;脊柱后凸角27°-89°,平均53.7°;躯干偏移4-26.8mm,平均18.8mm。结果手术时间平均321min,术中出血平均2400ml。术后平均随访16个月。侧凸Cobb’s角17°-57°,平均39.1°,平均矫正率55.5%;后凸Cobb’s角16°-42°,平均28.6°,平均矫正率48.7%;术后躯干偏移0-11.3mm,平均为3.4mm。手术并发症包括术中椎弓根骨折2例;胸腔积液2例;1例出现左上肢麻木,握力下降为3级。结论一期后路楔形截骨联合顶椎区广泛松解治疗严重脊柱侧后凸畸形是一个安全和有效的手术的手术技术。

Objective To explore the result and safety of vertebral column resection combined with release of the apical verte- brae for the severe rigid severe kyphoscoliosis. Methods From 2007 to 2015,there were 26 patients of severe rigid severe kyphoscoliosis who underwent posterior vertebral column resection combined with release of the apical vertebrae. There were 14 males and 12 females （from 15 to 45 years old） with an average age of 25.4 years. Type including signal hemivertebrae in 10 pa- tients, several hemivertebrae in 4 patients, adult idiopathic scoliosis in 8 patients, syringomyelia in 3 patients ,thoracic tuberculosis in 1 patient. The average preoperative Cobb＇s angel was 83.2^（range 74-118^）,and thoracic kyphosis angel was 53.7^（range 27^- 89^）. The average vertebral translation was 18.8mm（range 4-26.8mm）. Results The average operate time was 321 minute ,and the bleeding volume was 2400M1. All patients received followed up 16 months,the average postoperative Cobb＇s angel was 39.1~ （range17-57）,the correction rate was 55.5% on average, the average postoperative kyphosis angel was 28.6~ ,the correction rate was 48.7% on average.the average vertebral translation was 3.4mm （0-11.3mm）. Complications including pedieal fracture in 2 cas- es,pleural effusion in 2 cases,left upper extremity numbness With weakened grasp to 3 grate in 1 case. Conclusion One-stage posterior vertebral column resection combined with release of the apical vertebrae in the management of the severe rigid severe kyphoscoliosis was an effective and safe surgical technique.