全脊柱截骨联合前方钛网支撑治疗100°以上胸腰段角状后凸畸形  

Vertebral column resection combined with anterior mesh cage support in the treatment of throacolumbar kyphosis(≥100°)

作　　者：马华松[1] 谭荣[1] 吴继功[1] 陈志明[1] 王晓平[1] 周建伟[1] 袁伟[1] 刘涛[1] 

机构地区：[1]解放军306医院骨科全军脊柱外科中心,北京100101

出　　处：《中国矫形外科杂志》2012年第19期1754-1757,共4页Orthopedic Journal of China

摘　　要：[目的]探讨全脊柱截骨矫形联合应用前方钛网支撑治疗100°度以上胸腰段角状后凸畸形的治疗效果及临床应用价值。[方法]2008年3月～2011年3月采用经后凸顶椎全脊柱截骨矫形内固定、前方钛网植骨支撑治疗18例重度胸腰段角状后凸患者,男13例,女5例;年龄16～34岁,平均22.4岁。术前后凸Cobb角平均为122°(102°～175°),其中先天性脊柱后凸8例,陈旧结核性脊柱后凸6例,陈旧创伤性后凸2例,神经纤维瘤病性后凸2例。术前Frankel分级C级2例,D级3例,E级13例,均有不同程度的腰背疼痛。截骨部位均位于胸腰段后凸顶点。[结果]平均手术时间4.5 h(3.5～5.5 h),术中平均出血量2 020 ml(1 200～4 500 ml),术后后凸Cobb角平均28°(5°～51°),平均矫正率77%。术后平均随访23个月(11～33个月),末次随访Cobb角平均33°,平均丢失4°,X线显示截骨部位骨性融合。术中2例出现脑脊液漏,1例血压一过性下降。3例术后出现双下肢不全瘫痪,其中1例因截骨近端固定不稳再次翻修手术后恢复,2例保守治疗后恢复。末次随访时Frankel分级D级2例,E级16例。[结论]全脊柱截骨术联合应用前方钛网支撑治疗100°度以上胸腰段角状后凸畸形矫形效果良好,可避免脊柱过度短缩造成脊髓折皱,提高了手术安全性,但因畸形严重仍存在神经并发症风险。[ Objective ] To evaluate the efficacy and clinical value of vertebral column resection combined with anterior mesh cage support in the treatment of sharp throacolumbar kyphosis （ ≥100°） . [Methods] From Mar 2008 to Mar 2011, a total of 18 consecutive patients of throacolumbar kyphosis were treated with vertebral column resection and posterior instrumentation combined with anterior mesh cage support. There were 13 male and 5 female with an average age of 22. 4 years （16 - 34） . The average major Cobb angle of the kyphosis preoperative was 122° （102° - 175°） . There were 8 congenital scoliosis, 6 spinal tuberculosis, 2 post - trauma kyphosis and 2 Neurofibromatosis. According to the Frankel grading system, 2 cases were classified as grade C, 3 cases grading D and 13 grading E preoperatively. All of them had varying degrees of low back pain. The osteotomy sites were all in the thoracolumbar conjuction. [Results] The average operative time were 4. 5 h （3.5 -5.5 h） and the mean total blood loss were 2 020 ml （ 1 200 -4 500 ml） . The average major Cobb angle of the kyphosis post - operative were 28° （5° -51°） . They had an average follow -up period of 23 months （12-33 m） . The Cobb angle were 33° at the final follow up and the average ande lost was 4°. 2 cases had leakage of cerebrospinal ftuid and 1 case had transient of low blood pressure during the operation. 3 cases had incomplete paralysis after surgery, 1 case recovered after revision surgery and 2 cases recovered after conservative treatment. [ Conclusion] Vertebral column resection combined with anterior mesh cage support can get good deformity correction in the treatment of throacolumbar kyphosis （ ≥100° ） , it avoids too much shortening of the spine cord and increased safety of surgery, but attention still should be paid to the risk of neurologic complications.

关 键 词：脊柱后凸 截骨术 胸腰段 钛网 融合 

分 类 号：R687.3[医药卫生—骨科学]