一期后路闭合式-张开式联合楔形截骨术矫正角形脊柱后凸  

Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach

作　　者：Norio Kawahara 孙改生 田慧中[3] 

机构地区：[1]日本金汁尺大学医学院骨科 [2]新疆克拉玛依市人民医院骨科,834009 [3]新疆医科大学第六附属医院脊柱外科,830002

出　　处：《中国矫形外科杂志》2007年第17期1307-1312,共6页Orthopedic Journal of China

摘　　要：[目的]检验闭合式-张开式联合楔形截骨术治疗角形脊柱后凸的有效性和安全性。采用一期后路闭合式-张开式联合楔形截骨术的方法对7名患有胸腰椎角形脊柱后凸畸形的患者进行治疗。[方法]7名角形脊柱后凸患者,其后凸顶点位于T51例,位于T111例,位于T125例。其中5例存在有陈旧性骨折,1例为先天性畸形和1例患有神经纤维瘤病。首先用闭合式楔形截骨术将脊柱后凸矫正30°～35°,在施行椎骨切除术和脊髓减压时其矫正的中心点位于前纵韧带。随后用张开式楔形截骨术对残余的截骨角度予以矫正时,其矫正的中心点位于脊髓和剩余的截骨角之上。脊柱的稳定性则采用后路器械内固定和植骨予以保证。[结果]在2.2～7.5年的随访中,患者局部后凸的角度减少了67°～18°。自T1至骶骨的矢状位排列较术前更加符合生理曲线。所有的患者均获得了良好的骨质愈合并且没有神经性并发症发生,也没有矫正度数的丢失。[结论]在直视下,采用闭合式-张开式联合楔形截骨术的矫正效果和脊髓减压是令人满意和放心的。虽然手术的过程是异常艰巨的,但它却提供了一个没有脊髓损伤的、良好的矫正效果。[ Objective ] To examine the safety and efficacy of closing-opening wedege osteotomy for angular kyphosis. Seven patients with angular kyphotic deformity of the thoracic or thoracolumbar spine were treated by closing-opening wedge osteotomy using a single posterior approach. [ Method ] Seven patients with angular kyphosis were treated. The apex level of kyphosiswas T5 in one patient, T11 in one, and T12 in five. There was old fracture in five patients, congenital deformity in one, and neurofibromatosis in one. The first 30° -35° of kyphosis were corrected using the closing wedge technique with the hinge of the anterior longitudinal ligament after veretebrectomy and circumspinal decompression of the spinal cord. Then the hinge was moved posteriorly to the spinal cord and the remainder of the requisit angle of osteotomy was corrected using the opening-wedge technique （ closing-opening wedge osteotomy）. Spinal curvature was stabilized using posterior instrumentation and graft. [ Resuit] Localized kyphosis was reduced from and average of 67° to 18° at 2. 2 to 7.5 years＇ follow-up. Sagittal alignment from T1 to the sacrum became more physiologic than before. There were no neurologic complications. Bony fusion was achieved in all patients, and there was no correction loss. [ Conclusion ] Satisfactory correction is safely performed by closing-opening wedged osteotomy with a direct visuzlization of the cireumferentiall decompressed spinal cord. Although the performance is technically laborious, it offers good correction without jeopardizing the integrity of the spinal cord.

关 键 词：角形脊柱后凸 环脊髓减压 截骨矫正术 一期后路 

分 类 号：R687.3[医药卫生—骨科学]