成人特发性脊柱侧凸的后路截骨术  

Posterior osteotomy for the treatment of adult idiopathic scoliosis

作　　者：海涌[1] 苏庆军[1] 鲁世保[1] 周立金[1] 孟祥龙[1] 张岑山[1] 杨晋才[1] 关立[1] 王庆一[1] 

机构地区：[1]首都医科大学骨外科学系首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中国骨肿瘤骨病》2008年第4期221-224,共4页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：目的评价后路脊柱截骨术在治疗成人特发性脊柱侧凸的有效性和安全性。方法回顾性随访2000年1月至2004年12月间接受后路截骨矫形固定融合术并随访2年以上的53例成人特发性脊柱侧凸,男13例,女40例,平均年龄31.2岁(20～48岁)。按照弯曲部位分别为单胸弯23例,胸腰弯15例,双胸弯7例,胸腰双弯8例。术前平均胸椎Cobb角58.8。(44～93),腰椎49.5。(35。～79。),平均柔韧度胸椎28.2%,腰椎37.1%。躯干偏移平均38mm(3～79mm)。本组中37例术前合并腰背痛,5例合并椎管或神经根管狭窄所致的下肢症状。所有患者接受一期后路选择性经关节突椎板截骨矫正、经椎弓根固定融合术。通过病例查阅、X线片测量以及问卷随访,评价矫正情况和功能情况。结果所有患者均安全完成手术,无神经损伤等严重并发症发生。平均截骨节段3.1个(2～5个),平均手术时间3.5h(2.8～5.2h),平均出血量892ml(750～1520ml)。所有患者均获得2年以上随访(2～5年)。术后胸椎侧凸平均17.2。(19。～47。),最终随访时平均19.8。(11。～49。)。术后腰椎侧凸平均16.7。(7。～23。),最终随访时平均18.9。(8。～26。)。术后躯干偏移平均为11mm(0～21mm),平均矫正71%。37例术前存在腰背痛者35例最终随访时腰背痛消失,5例术前存在下肢症状者术后完全消失。结论成人特发性脊柱侧凸行后路经关节突和椎板截骨可以获得满意矫正,疼痛症状缓解,是治疗成人特发性脊柱侧凸的安全有效的手术方法。Objective To evaluate the efficacy and safety of posterior spinalosteotomy for adult idiopathic scoliosis. Methods A retrospective review study was conducted. From January, 2000 to December, 2004, 53 patients who sustained adult idiopathic scoliosis were treated with one stage posterior osteotomy. All patients with more than two years follow up were reviewed retrospectively. There were 13 men and 40 women, with an average age of 31.2 years （aged from 20 to 48）. The patients were categorized into 4 curve types according to the location of onset： single thoracic curve in 24 patients, thoracolumbar curve in 15, double thoracic curve in 7, and combined thoracic and lumbar curves in 8. The average pre-operative Cobb angle was 58.8 degree （44-93） for thoracic curve and 49.5 degree （35 -79） for lumbar curve, respectively. The curve flexibility was 28.2% for thoracic curve and 37.1% for lumbar curve. The average trunk coronal lateral translation was 38ram （3 - 79ram）. Thirty-seven patients had back pain preoperatively and 5 patients showed symptoms of radicularpathy in lower extremities. All patients underwent one stage posterior trans-articular joints and laminar osteotomy （Smith-Peterson Procedure）, trans-pedicular fixation and fusion with autogenous bone graft. The radiographic and clinical outcomes were evaluated by charts review, X-ray and telephone or mail questionnaire. Results All patients underwent surgery safely. No neurological injury occurred. The number of levels of osteotomy was 3.1 in average （2-5）. The average surgery time was 3.5 hours （2.8-5.2） and the average blood loss was 892ml （750-1520ml）. All patients were followed up for at least 2 years （2-5）. The average post-operative Cobb angle was 17.2 degree （19-47） for thoracic curve, 16.7 degree （7-23） for lumbar curve, 19.8 degree （11-49） for thoracic curve, and 18.9 degree （8-26） for lumbar curve at latest follow up. The average trunk coronal lateral translation was reduced tol 1mm （0-21mm） （71

关 键 词：成人 特发性脊柱侧凸 后路截骨术 

分 类 号：R687.3[医药卫生—骨科学]