后路病椎切除经椎弓根内固定治疗儿童及青少年先天性脊柱侧后凸畸形  

POSTERIOR DEFORMITY VERTEBRA RESECTION WITH PEDICLE INSTRUMENTATION IN TREATMENT OF CONGENITAL SCOLIOSIS OR KYPHOSCOLIOSIS IN CHILD AND ADOLESCENT PATIENTS

作　　者：王迎松[1] 鲁宁[1] 张颖[1] 刘路平[1] 赵智[1] 杨振东[1] 赵道洪[1] 陈鸿[1] 解京明[1] 

机构地区：[1]昆明医学院第二附属医院骨科,昆明650101

出　　处：《中国修复重建外科杂志》2010年第4期424-429,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨后路病椎切除、经椎弓根内固定治疗儿童及青少年先天性脊柱侧后凸畸形的方法选择,评价其临床效果。方法2003年5月-2007年12月,收治28例先天性脊柱侧凸和后凸畸形患者。其中男11例,女17例;年龄1.5～17.0岁,平均9.6岁。病椎位于胸段13例,胸腰段10例,腰段5例。依据病椎类型及畸形范围,采取不同经后路病椎切除方式:半椎体切除(13例)、半椎体切除联合对侧分节不全切除(7例)、全脊椎切除(8例)。均依靠椎弓根螺钉器械行矫形内固定术,其中短节段固定7例(A组),长节段固定、单纯半椎体或联合对侧骨桥切除13例(B组),长节段固定、全脊椎切除8例(C组)。记录各组患者手术时间及出血量,测量侧凸及后凸角度并计算矫正率。结果A、B、C组手术时间分别为(98±17)、(234±42)、(383±67)min,出血量分别为(330±66)、(1540±120)、(4760±135)mL,3组间比较差异均有统计学意义(P<0.05)。术后患者切口均Ⅰ期愈合,无深部感染、呼吸衰竭或深静脉血栓等并发症发生。1例C组患者于术后6h出现脊髓再灌注损伤,经积极治疗后2周恢复正常;余患者无神经系统并发症发生。28例均获随访,随访时间24～72个月,平均32.8个月。影像学资料示术后6个月植骨融合良好,有连续性骨性结构连接病椎切除后间隙,手术所获矫形角度无明显丢失。所有患者无螺钉松动或拔钉等现象发生。术后2周X线片示3组侧凸及后凸角度与术前比较差异均有统计学意义(P<0.01)。A、B组侧凸矫正率显著高于C组(P<0.05),A、B组间差异无统计学意义(P>0.05);A、C组后凸矫正率低于B组(P<0.05),A、C组间差异无统计学意义(P>0.05)。结论后路病椎切除可直接去除致畸因素,在冠状面和矢状面均可获得良好的矫形,手术计划应结合患者年龄,针对不同的致畸因素及畸形情况,选择恰当的手术方式及固定范围。Objective To discuss operative strategies of posterior deformity vertebra resection and instrumentation fixation in the treatment of congenital scoliosis or kyphoscoliosis in child and adolescent patients,and to evaluate the surgical results.Methods From May 2003 to December 2007,28 patients with congenital scoliosis or kyphoscoliosis were treated with one stage posterior deformity vertebra resection.There were 11 males and 17 females with an average age of 9.6 years （1.5-17.0 years）.The locations were thoracic vertebra in 13 cases,thoracolumbar vertebra in 10 cases,and lumbar vertebra in 5 cases.All the patients underwent one stage posterior deformity vertebra resection,fusion and correction with pedicle instrumentation.According to different types of deformities,the patients underwent three different surgeries：hemivertebra resection（13 patients）,hemivertebra resection combined contralateral unsegmental resection（7 patients）,and total vertebral column resection（8 patients）.Based on short or long segmental pedicle instrumentation,deformities were corrected and fixed,in 7 patients with short segmental fixation（group A）,in 13 patients with long segmental fixation with hemivertebra resection or combined contralateral unsegmental resection（group B）,and in 8 patients with long segmental fixation with total vertebral column resection（group C）.The operative duration and the volume of blood loss were recorded,and the correction rate was calculated through measurement of Cobb angles of scoliosis and kyphosis before and after operation.Results The operation time of groups A,B,and C was（98±17）,（234±42）,and（383±67）minutes,respectively,and the blood loss during operation was（330±66）,（1 540±120）,and（4 760±135）mL,respectively;showing significant differences among three groups（P0.05）.All patients achieved one-stage healing of incision.No deep infection,respiratory failure or deep vein thrombosis occurred.One patient had the signs of ischemical reperfusion injury of

关 键 词：脊柱侧凸 脊柱后凸 脊柱融合术 内固定 

分 类 号：R687.3[医药卫生—骨科学]