节段性椎弓根钉系统治疗伴发脊髓空洞的脊柱侧凸  

Treatment of scoliosis associated with untreated syringomyelia using segmental pedicle screw system

作　　者：刘一[1] 张绍昆[1] 闫明[1] 付长峰[1] 赵松[1] 牛丰[1] 张琪[1] 

机构地区：[1]吉林大学白求恩医学部第一临床医学院脊柱外科,长春130021

出　　处：《中华骨科杂志》2009年第5期441-444,共4页Chinese Journal of Orthopaedics

摘　　要：目的评价节段性椎弓根钉系统治疗伴发脊髓空洞的脊柱侧凸的手术疗效。方法应用节段性椎弓根钉系统治疗伴发脊髓空洞的脊柱侧凸35例。合并ChiariⅠ型畸形12例（34.3％）。典型侧凸18例，不典型侧凸17例。所有患者术前均未接受任何针对脊髓空洞的治疗措施。手术分组：（1）一次手术组（30例）：患者手术年龄〉10岁，一次性后路节段性椎弓根钉系统矫形内固定植骨融合术。（2）二次手术组（5例）：患者年龄≤10岁，一期手术行可自行延长的节段性椎弓根钉系统矫形手术，4-6年后行二期矫形内固定植骨融合术。结果术前冠状面主弯Cobb角平均66．5°（32°-121°）；术后平均22．6°（0°-78°），平均矫正率69．4％（31％-100％）；平均随访58．4（13-113）个月，末次随访时冠状面主弯Cobb角3°-78°，平均25．9°，最终矫正率63．9％。6例随访时出现追加现象，其中5例融合下端椎没有融合至稳定椎。术后出现腹壁反射消失1例，浅感觉减退范围扩大1例，未予处理。结论对于伴发未经治疗的非扩张型脊髓空洞的脊柱侧凸，如果术前无或仅伴随轻微神经损害症状，可以直接采用后路节段性椎弓根钉系统进行矫形治疗，建议对这类脊柱侧凸远端应融合至稳定椎。Objective To evaluate the surgical results of scoliosis associated with untreated sy- ringomyelia with segmental pedicle screw system. Methods Thirty-five patients of scoliosis associated with untreated syringomyelia were treated with segmental pedicle screw system. Twelve eases were associated with type Ⅰ Chiari malformation. The curve patterns covered atypical curve in 18 cases and atypical curve in 17 cases. There were two groups of operations： 1） Thirty cases, older than 10 years, underwent single-stage posterior correction, pedicle screw system internal fixation and bone-graft fusion; 2） Five cases, younger than 10 year, firstly underwent posterior correction and internal fixation with growth rod, and then posterior correction, internal fixation and bone-graft fusion 4-6 years later. Results The average coronal Cobb angle measured 66.5° （range, 32°-121°） preoperatively and 22.6° （range, 0°-78°） postoperatively. The average correction rate was 69.4% （range, 31%-100%）. All the 35 cases were followed up 58.4 months in average （range, 13-113 months）. The average coronal Cobb angle measured 25.9° （range, 3°-78°） at the latest follow-up. Six cases experienced deformity progressive after surgery. The caudal fusion vertebra was not fixed down to the stable vertebra in five of the six cases. It was shown absence of superficial abdominal reflex in one case, and expansion of sensory deficit in another one cases. Neither of two cases needed further management. Conclusion Segmental pedicle screw instrumentation is a safe procedure in treatment of scoliosis associated with untreated syringomyelia except Chiari malformation with distended type syringomyelia. Arthrodesis should be ended at the stable vertebra in the treatment of scoliosis associated with syringomyelia.

关 键 词：脊柱侧凸 脊髓空洞症 骨螺丝 

分 类 号：R686[医药卫生—骨科学]