成人胸腰段或腰段脊柱侧凸合并Chiari畸形和脊髓空洞症的三维矫形及融合策略  

Strategy of 3D spinal correction and fusion for adult thoracolumbar or lumbar scoliosis associated with Chiari malformation and syringomyelia

作　　者：张宏其[1] 邓盎[1] 陈凌强[1] 刘少华[1] 赵迪[1] 王永福[1] 王昱翔[1] 吴建煌[1] 刘金洋[1] 

机构地区：[1]中南大学湘雅医院脊柱外科湘雅脊柱外科中心,长沙市410008

出　　处：《中国矫形外科杂志》2009年第23期1770-1774,共5页Orthopedic Journal of China

基　　金：湖南省科技厅科技计划一般项目(06SK3015;2007SK3036);湖南省卫生厅科研课题一般项目(B2006-040)

摘　　要：[目的]探讨合并Chiari畸形和脊髓空洞症的成人胸腰段或腰段脊柱侧凸的三维矫形及融合策略。[方法]回顾性研究2002年1月～2008年5月本科收治的13例合并Chiari畸形和脊髓空洞症的成人胸腰段或腰段脊柱侧凸,全部采用后路椎弓根螺钉系统三维矫形,并根据侧凸结构性特点选择内固定及融合节段。测量术前、术后、末次随访时冠状面Cobb’s角、侧凸矫正率、骨盆倾斜、顶椎旋转度、顶椎偏距、躯干偏移、矢状面胸椎后凸角和腰椎前凸角。[结果]冠状面Cobb’s角从46.8°减少到9.2°,侧凸矫正率80.7%;骨盆倾斜从9.9°减少到3.2°;顶椎旋转度从1.9°减少到0.3°;顶椎偏距从3.6cm减少到0.8cm;躯干偏移从16.8cm减少到1.6cm;胸椎后凸角从18.2°增加到23.5°;腰椎前凸角从37.4°增加到41.8°。术后平均随访22.2个月,无明显矫形丢失、躯干失平衡、假关节形成,且未发生原有神经症状加重及新的不可逆性神经功能损害。[结论]后路椎弓根螺钉系统三维矫形及融合术治疗合并Chiari畸形和脊髓空洞症的成人胸腰段或腰段脊柱侧凸效果满意。[Objective]To study the strategy of 3D spinal correction and fusion for adult thoracolumbar or lumbar scoliosis associated with Chiari malformation and syringomyelia.[Methods]From January 2002 to May 2008,13 elderly patients suffered from thoracolumbar or lumbar scoliosis associated with Chiari malformation and syringomyelia underwent 3D spinal correction with posterior pedicle screws instrumentations and fusion according to their curve features.Parameters of pre-,post-operation and final follow-up included coronal plane Cobb＇s angle,correction rate,pelvic obliquity,apical vertebral rotation,the relationship in distance from the apex to the central sacral vertical line（CSVL）and the vertical from C7 to the CSVL,in sagittal plane thoracic kyphosis angle and lumbar lordosis angle were recorded.[Results]In coronal plane Cobb＇s angle was from 46.8° to 9.2°,correction rate was 80.7%,pelvic obliquity was from 9.9° to 3.2°,apical vertebral rotation was from 1.9° to 0.3°,the distance from the apex to the CSVL was from 3.6cm to 0.8cm,the distance of the vertical from C7 to the CSVL was from 16.8cm to 1.6cm,in sagittal plane thoracic kyphosis angle was from 18.2° to 23.5°,lumbar lordosis angle was from 37.4° to 41.8°.The patients were followed up for 22.2 months.There were no obvious loss of correction,trunk equilibrium or pseudoarthrosis.No worsened neural symptoms or new irreversible neural functional lesion were found.[Conclusion]3D spinal correction with posterior pedicle screws instrumentations and fusion according to the curve features have excellent results in treating adult thoracolumbar or lumbar scoliosis associated with Chiari malformation and syringomyelia.

关 键 词：脊柱侧凸 CHIARI畸形 脊髓空洞症 矫形 脊柱融合 

分 类 号：R687.3[医药卫生—骨科学]