后路全脊椎截骨矫形治疗成人先天性脊柱后凸畸形  

Posterior total vertebra osteotomy for congenital kyphosis deformity in adults

作　　者：郭继东[1] 史亚民[1] 侯树勋[1] 李利[1] 王华东[1] 马超[1] 

机构地区：[1]解放军总医院第一附属医院骨科,北京100037

出　　处：《中国骨肿瘤骨病》2011年第3期255-258,共4页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：目的探讨后路全脊椎截骨治疗成人先天性脊柱后凸的疗效和安全性。方法 2004年2月至2008年11月,对11例成人先天性脊柱后凸的患者进行了经顶椎全脊椎截骨联合椎弓根螺钉系统内固定手术治疗。其中男4例,女7例;年龄24～49岁,平均31.9岁。术前脊柱后凸Cobb's角62～102°,平均79.4°。伴神经压迫症状者9例。所有患者均行后路一期经顶椎全脊椎截骨、经椎弓根固定、植骨融合术,截骨平面T_9～L_2。结果所有患者安全接受手术,无神经损伤,内固定失败等严重并发症发生。手术时间3.2-4.8h,平均3.6h。术中出血量750～1500ml,平均990ml;围手术期总出血量1450～2200ml,平均1722ml。术后10d左右佩戴支具下地,6例术前神经压迫症状者术后即有不同程度的恢复,2例1年随访有改善,1例无明显变化。术后后凸Cobb's角10～32°,平均21.8°;矫正率72.5%。随访时间12-39个月,平均16.6个月。术后1年随访时所有患者对治疗结果表示满意,矫正丢失率为2.7%。结论后路一期全脊椎截骨术治疗成人先天性脊柱后凸手术相对安全,矫正效果良好。通过节段椎弓根螺钉系统固定重建脊柱稳定性,配合支具外固定,患者可在术后早期下地活动。Objective To evaluate the efficacy and safety of posterior total vertebral osteotomy for the congenital kyphosis deformity in adults. Methods From February 2004 to November 2008, 11 adult patients with congenital kyphosis were performed with the surgery of total vertebra osteotomy and pedical screws internal fixation system. The average age was 31.9 years （rang, 24-49 years） with 4 male and 7 female cases respectively. The preoperative kyphosis cobb＇s angle was 62-102% with an everage of 79.4%. There were 9 patients with neurological deficit pre-operatively. All the patients underwent posterior total average osteotomy on the apex vertebral, transpedicular fixation combined with bonegraft fusion, the level of osteotomy varied from T9 to L2. Results All the patients were performed the operation successfully and none of them developed severe complication of neurological injury or hardware failure. The everage surgery time was 3.6 h （3.2-4.8h）. The average blood loss during the operation was 990ml （750-1500ml） while during perioperative period was 1722ml （1450-2200ml）. Promotion of neurological function was found immediately after the surgery in 6 cases, 2 cases in 1 year follow-up and 1 case showed no improvement during the follow-up period. The post-operative average kyphotic curve was 21.8 （10-32°）. The correction rate was 72.5%. The average time of follow-up was 16.6m （12-39m）. All the patients were satisfied with the results the loss of correction was 2.7% at 1 year follow-up. Conclusions One-stage posterior total vertebra osteotomy is a safe and effect technique foe managing congenital kyphosis deformity in adults. The spinal balance and stability can be restored with pedicle screws system fixation, and patients are able to ambulate with brace more early after the surgery.

关 键 词：先天性 脊柱后凸 截骨矫形 椎弓根螺钉系统内固定 

分 类 号：R687.3[医药卫生—骨科学]