手术治疗严重脊柱角状后凸畸形临床疗效分析

Clinical Analysis of Surgical Treatment of Severe Angular Kyphosis

目的:探讨后路全脊柱截骨(posterior vertebral column resection,PVCR)联合钛网植骨内固定治疗严重脊柱角状后凸畸形的短期临床疗效。方法:回顾性分析2014年1月-2016年3月在本科收治的16例严重脊柱角状后凸畸形患者,所有患者均行后路全脊柱截骨联合钛网植骨内固定治疗。记录手术时间、术中出血量、脊柱矫形术前、术后、末次随访Cobb角、C7铅垂线距S1后上缘距离,脊髓Frankel变化。结果:所有患者术后均获得随访,随访时间8~24个月,平均15.2个月。患者腰背部疼痛及畸形得到明显改善,无切口及椎体深部感染。1例患者出现少量胸腔积液,经治疗后吸收,术后无内固定松动、断裂,植骨融合效果好。3例患者因术中牵拉,神经根水肿,术后神经症状加重,但经脱水及神经营养治疗后,症状缓解。术中出血量1500~4000 m L,平均2360.6 m L,手术时间230~450 min,平均340.2 min。Cobb角术前83°~145°,平均110.3°;术后:16°~95°,平均41.3°,矫正率为59.6%;末次随访18~100°,平均44.6°,矫正丢失率为5.6%。C7铅垂线距S1后上缘距离术前-37~49 mm,平均31.2 mm,术后:-13~22 mm,平均11.2 mm,矫正率为:64.1%;末次随访:-11~21 mm,平均10.3 mm,矫正丢失率为8.1%。Frankel评分术前B级2例,C级4例,D级10例;末次随访B级0例,C例1例,D级2例,E级13例。结论:经后路全脊柱截骨联合钛网植骨内固定手术治疗严重脊柱角状后突畸形能明显矫正脊柱后突畸形、有效解除顶点区脊髓的压迫,促进神经功能恢复,是一种不错的临床治疗方法。但该手术时间长、出血多、手术技术难度大,应充分做好术前准备。

Objective： To investigate the short term clinical efficacy of posterior vertebral column resection combine with titanium mesh and bgne grafting in the treatment of severe angular kyphosis.Method： From January 2014 to March 2016 in our department, 16 cases with severe spinal angular kyphosis were retrospectively analysed, and were treated with posterior vertebral column resection combined with titanium mesh and bone graft and internal fixation.The operation time, intraoperative bleeding, Cobb angle before, after surgery and finalfollow-up, distancefrom C7 plumb line to S1 upperposterior edge and frankel＇s standard were recorded. Result： All patients were followed up after operation, the follow-up time ranged from 8 to 24 months, average 15.2 months.Patients with low back pain and deformity were improved significantly, without incision and vertebral deep infection. 1 cases presented pleural effusion and it was absorbed after treatment, without internal fixation loosening and fracture, bone graft fusion effect was good.For intraoperative traction, 3 patients presented nerve root edema and postoperative neurological symptoms increased, but after dehydration and nerve nutrition therapy, symptoms relieved.The intraoperative blood loss was 1500-4000 mL, average 2360.6 mL, operation time： 230- 450 min, average 340.2 min.Preoperative Cobb angle： 83°- 145°, average 110.3° ; after the operation ： 16°-95°, average 41.3°, the correction rate was 59.6%; the last follow-up： 18°-100°, average 44.6°, the correction of loss rate was 5.6%.Preoperative distaneefrom C7 plumb line to S1 upperposterior edge： -37-49 mm, average 31.2 mm; postoperative： -13-22 mm, average 11.2 mm, the correction rate was 64.1%; at the end of the follow- up： -11-21 ram, average 10.3 mm, the correction loss rate was 8.1%.Frankel score before operation： B grade 2 cases, C cases 4 cases, D grade 10 cases, the last follow-up： B grade 0 case, C grade 1 case, D grade 2 cases, E grade 13 cases.Conclusion： Posterior vertebral column resection combined with titanium mesh and bone graft and internal fixation in the treatment of severe spinal angular kyphosis can obviously correct kyphosis, effectivelyrelieve spinal cord vertex area, promote the recovery of neurological function, it is a good clinical treatment.But the operation time is long, intraoperative bleeding is large, surgery technical is difficult, it is needed to make full preoperative preparation.