后路松解胸椎间隙联合楔形截骨治疗重度僵硬性脊柱侧后凸  

Treating severe and rigid kyphoscoliosis with posterior thoracic intervertebral space release and wedge osteotomy

作　　者：李超[1] 周宇[1] 付青松[1] 赵刚[1] 千阜生[1] 周洪翔[1] 

机构地区：[1]安徽省阜阳市人民医院骨科,236003

出　　处：《中华骨科杂志》2008年第6期448-452,共5页Chinese Journal of Orthopaedics

摘　　要：目的 评价经后路胸膜外松解胸椎间隙联合顶椎区楔形截骨结合椎弓根螺钉内固定矫正术治疗重度僵硬性脊柱侧后凸畸形的安全性和早期临床效果。方法 2004年3月至2007年6月，对14例重度僵硬性脊柱侧后凸患者行手术治疗。男6例，女8例；年龄15-31岁，平均22．1岁。其中特发性7例，先天性6例，神经纤维瘤病1例。术前侧凸Cobb角81°-139°，平均111．2°；后凸57°-165°，平均85．8°。所有患者均行一期经后路胸膜外松解椎间隙联合顶椎区楔形截骨，经椎弓根螺钉内固定矫正及植骨融合术。结果 平均松解椎间隙5．1个，椎体截骨平均2.3个，手术时间7．2-14．1h，平均9．2h。术中出血量1500-6100ml，平均3970ml。无神经损伤，2例术中胸膜破裂，1例术后并发肠系膜上动脉综合征。所有患者经过7-31个月随访，平均12．7个月，术后侧凸Cobb角15°-71°平均31.3°，矫正率71．9％；后凸22°-48°平均34．9°矫正率59．3％。结论 经后路胸膜外松解胸椎间隙节省了前路经胸的手术时间，创伤小，对心肺干扰小，降低了风险，改善了脊柱柔韧性。顶椎区凸侧三柱楔形截骨，依靠凹侧保留的椎间纤维环、黄韧带及肋椎关节作为稳定铰链，手术较全脊椎切除术简便、安全。对重度僵硬性弧形脊柱侧后凸用单一的截骨术难以达到三维矫正，后路椎间隙松解联合顶椎区楔形截骨结合椎弓根螺钉内固定矫正能获得良好的脊柱三维矫正。Objective To evaluate the early result of the efficacy and safety of posterior thoracic intervertebral space release and wedge osteotomy for severe and rigid kyphoseoliosis, Methods From 2004 to 2007, twelve patients with severe and rigid kyphoseoliosis were treated with posterior thoracic intervertehral space release and wedge osteotomy on the apex vertebra, Trans-pedieular screws fixation and fusion were used after deformity correction, There were 6 males and 8 females with an average age of 22,1 years （15-31 years old ）, The average pre-operative seoliosis cobb angle was 111.2°（81°-139°） and kyphosis cobb angle was 85.8° （57°-165°） before operation. Results All patients were followed up for 7-31 months （months averagely）. An average of 5.1 thoracic vertebra were released and 2.3 vertebra were wedge reseeted. The average surgery time was 9.2 hours and average blood loss volumn of 3970 ml （1500-6100 ml）. There were no major complication of neurological injury and hardware failure. There were 2 cases pleura rupture during the operation and 1 cases of superior mesenteric artery syndrome after the surgery. The postoperative average scoliosis and kyphotic curve was 31.3° （15°-71°and 34.9°（22°-48°）, respectively.The correction rate for scollosis and kyphotic was 71.9% and 59.3%, respectively. Conclusion Costotransversec- tomy release of thoracic vertebra via single posterior approach can avoid open chest surgery and reduce the disturbance of heart and lung. The wedge osteotomy of the vertebral column at the apex of the deformity based on the preserved annulus fibrosus and ligment flavum and costovertebral joints in spinal concave side can keep the segmental stability and increase the surgery safety. Posterior thoracic intervertebral space release and wedge osteotomy is proved to be an effective and safe way for severe and rigid kyphoscoliosis.

关 键 词：脊柱侧凸 脊柱后凸 截骨术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]