一期后路全脊椎切除术治疗严重僵硬性脊柱畸形的疗效  

The efficacy and complications of one stage posterior vertebral column resection for severe spinal deformities

作　　者：仉建国[1] 王升儒[1] 邱贵兴[1] 王以朋[1] 于斌[1] 孙武[1] 姜鹏翔[1] 彭慧明[1] 

机构地区：[1]北京协和医院骨科中国医学科学院北京协和医学院,100730

出　　处：《中华外科杂志》2010年第22期1694-1700,共7页Chinese Journal of Surgery

摘　　要：目的 评价一期后路全脊椎切除治疗严重僵硬脊柱畸形的临床效果和并发症.方法 回顾性分析2008年1月至2010年1月接受一期后路全脊椎切除治疗的15例严重脊柱侧后凸患者的临床资料.其中男性4例,女性11例;年龄7～53岁,平均22岁.诊断包括先天性脊柱侧后凸10例,特发性脊柱侧后凸1例,先天性脊柱后凸3例,陈旧性结核性后凸1例.均采用椎弓根螺钉技术,其中初次手术12例,翻修手术3例.通过站立位全脊柱正侧位X线片,测量手术前后冠状面和矢状面节段性Cobb角、躯干偏移以及矢状面平衡情况,同时记录围手术期以及迟发并发症情况.结果 平均切除椎体1.8个,其中单椎体8例,2椎体5例,3椎体1例,5椎体1例.手术时间240～450 min,平均331 min;出血量800～3000 ml,平均1453 ml.随访时间3～24个月,平均13个月.冠状面节段性侧凸由术前的111°矫正至51°,末次随访53°,矫形率为54.0%;矢状面节段性后凸由术前的104°矫正至39°,末次随访42°,矫形率为62.5%;躯干偏移术前为19.5 mm,术后18.1mm,末次随访12.4 mm;矢状面平衡术前为20.0 mm,术后-2.0 mm,末次随访-1.1 mm.术中3例发生壁层胸膜撕裂;2例患者术后出现一过性一侧下肢肌力减退,6个月随访时恢复正常;1例出现季肋部束带感.结论 一期后路全脊椎切除是治疗严重脊柱畸形的一种有效术式,但对手术技术要求高,应充分重视术中和术后神经系统并发症.Objective To evaluate the outcomes and complications of posterior vertebral column resection in the treatment of severe and fixed spinal deformities. Methods From January 2008 to January 2010,15 consecutive cases （4 males, 11 females） of severe and fixed spinal deformities managed by single posterior vertebral column resection with transpedicular instrumentation were investigated retrospectively. The diagnosis included congenital scoliosis in 10 cases, adolescent idiopathic scoliosis in 1 case, congenital kyphosis in 3 cases, tuberculous kyphosis 1 case. Radiograghs were measured to determine the regional coronal and sagittal curve magnitude, and the coronal and sagittal balance preoperatively, postoperatively and at the final follow-up. Operative reports and patient charts were reviewed to record operation time, introoperative blood loss and complications. Results The mean resected vertebrae was 1.8 （ range, 1-5）. The mean operation time was 331 min （range, 240-450 min） with an average blood loss of 1453 ml （range, 800-3000 ml）. The average follow-up time was 13 months （range, 3-24 months）. The regional scoliosis was corrected from 111° to 51°with a correction rate of 54. 0%, and regional kyphosis from 104° to 39° with a correction rate of 62.5%. No obvious loss of correction was noted at the final follow-up. The coronal trunk shift improved from 19. 5 mm preoperatively to 18. 1 mm postoperatively and 12. 4 mm at final follow-up. The sagittal balance improved from 20. 0 mm preoperatively to - 2. 0 mm postoperatively and - 1. 1 mm at the final follow-up. Complications included partial pleural rupture requiring repair in 3 cases, transient muscle weakness of one lower limb after surgery but recovered completely at 6 month follow-up in 2 cases, and tightness of thorax after surgery in one case. Conclusions Posterior vertebral column resection is effective in treatment of severe and rigid spinal deformities. But it is a technique-demanding procedure with higher risks of major neurologic compl

关 键 词：脊柱侧凸 脊柱后凸 截骨术 手术入路 

分 类 号：R686[医药卫生—骨科学]