经后路一期脊柱矫形术治疗伴ChiariⅠ型畸形的青少年脊柱侧凸  

ONE-STAGE POSTERIOR APPROACH AND PEDICLE INSTRUMENTATION FOR CORRECTION OF SCOLIOSIS ASSOCIATED WITH Chiari I MALFORMATION IN ADOLESCENT

作　　者：王迎松[1] 解京明[2] 张颖[2] 赵智[2] 杨振东[2] 刘路平[2] 赵伟[2] 唐一平[3] 

机构地区：[1]昆明医学院第二临床学院,昆明650031 [2]昆明医学院第二附属医院骨科 [3]昆明医学院第二附属医院神经外科

出　　处：《中国修复重建外科杂志》2010年第12期1489-1493,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的分析伴ChiariⅠ型畸形的脊柱侧凸青少年患者的临床特点,并探讨经后路一期脊柱矫形术治疗的有效性和安全性。方法 2004年10月-2008年8月,收治17例伴ChiariⅠ型畸形的脊柱侧凸患者。男9例,女8例;年龄12～19岁,平均15.1岁。1例无脊髓空洞,16例脊髓空洞分布于颈段或颈胸段。侧凸顶椎位于T7～12。其中9例侧凸或后凸严重(>90°),或合并明显神经功能障碍者行经后路全脊椎切除加椎弓根器械矫形(全脊椎切除组);余8例行单纯经后路椎弓根器械矫形(单纯矫形组)。手术固定并融合范围均自上胸段延伸至腰段。均未行颅颈区后路减压术。结果全脊椎切除组手术时间(384±65)min,出血量(4160±336)mL;单纯矫形组手术时间(246±47)min,出血量(1450±213)mL;两组比较差异均有统计学意义(P<0.05)。全脊椎切除组术中1例发生凝血机制紊乱,4例胸膜穿破,术后1例肺部感染;单纯矫形组1例术中出现胸膜穿破;均经对症治疗后好转。17例均获随访,随访时间24～36个月,平均32.5个月。全脊椎切除组植骨间隙均于术后6～12个月获骨性融合。两组均未出现内固定物断裂或拔出。术后1周两组侧凸角及后凸角均较术前显著改善(P<0.01);全脊椎切除组侧凸和后凸矫正率分别为63.4%±4.6%和72.1%±5.8%,单纯矫形组分别为69.4%±17.6%和48.8%±19.3%,前者矫形效果好于后者。结论对伴ChiariⅠ型畸形的脊柱侧凸青少年患者,并非必须于矫形术前行颅颈区神经减压术;对于存在严重且僵硬的脊柱畸形,或已表现神经功能损害者,经后路全脊椎切除术能实现对脊髓的安全保护。Objective To analyze the clinical features of scoliosis associated with Chiari I malformation in adolescent patients, and to explore the validity and safety of one-stage posterior approach and vertebral column resection for the correction of severe scoliosis. Methods Between October 2004 and August 2008, 17 adolescent patients with scoliosis associated with Chiari I malformation were treated with surgical correction through posterior approach and pedicle instrumentation. There were 9 males and 8 females with an average age of 15.1 years （range, 12-19 years）. The MRI scanning showed that 16 of 17 patients had syringomyelia in cervical or thoracic spinal cord. Apex vertebra of scoliosis were located at T7-12. One-stage posterior vertebral column resection and instrumental correction were performed on 9 patients whose Cobb angle of scoliosis or kyphosis was more than 90°, or who was associated with apparent neurological deficits （total spondylectomy group）. Other 8 patients underwent posterior instrumental correction alone （simple correction group）. All patients’ fixation and fusion segment ranged from upper thoracic spine to lumbar spine. Results The operative time and the blood loss were （384 ± 65） minutes and （4 160 ± 336） mL in total spondylectomy group, and were （246 ± 47） minutes and （1 450 ± 213） mL in simple correction group; showing significant differences （P 0.05）. In total spondylectomy group, coagulation disorder occurred in 1 case, pleural perforation in 4 cases, and lung infection in 1 case. In simple correcction group, pleural perforation occurred in 1 case. These patients were improved after symptomatic treatment. All patients were followed up 24-36 months （32.5 months on average）. Bony healing was achieved at 6-12 months in total spondylectomy group. No breakage or pulling-out of internal fixator occurred. The angles of kyphosis and scoliosis were signifi cantly improved at 1 week after operation （P 0.01） when compared with those before operation. The c

关 键 词：脊柱侧凸 CHIARI畸形 脊柱融合术 内固定 青少年 

分 类 号：R687.3[医药卫生—骨科学]