蛋壳技术联合多椎板切除治疗成人先天性脊柱畸形  

Eggshell procedure combined with multi-segmental laminectomy for congenital spinal deformity in adults

作　　者：汤育森[1,2] 丁真奇[1,2] 林坤山[1,2] 何明长[1,2] 刘晖[1,2] 林达生[1,2] 

机构地区：[1]解放军第175医院骨科医院 [2]厦门大学附属东南医院,福建漳州363000

出　　处：《临床骨科杂志》2012年第5期483-486,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨蛋壳技术联合多椎板切除治疗成人先天性脊柱畸形的安全性及有效性。方法 13例先天性脊柱畸形患者均采用后正中切口,通过蛋壳技术去除椎体松质骨使原发弯顶椎变为空壳样,顶椎相邻节段椎板全切除,应用平移、去旋转结合凸侧加压、凹侧撑开钉棒系统内固定矫正,同时行自体骨混合同种异体骨脊柱后外侧植骨融合治疗。结果 13例共切除36个节段椎板;行蛋壳技术的椎体共16个;融合节段8～15个。手术用时230～430(305.4±62)min;术中出血量1 800～3 900 ml(2 646±651)ml。13例均获得随访,时间18～82(43.5±7.6)个月。末次随访时,脊柱主弯侧凸矫正率为49.2%,后凸矫正率为48.8%。未发现螺钉断裂、松动,无断棒现象。1例术后出现脑脊液漏,1例在末次随访时主诉有轻度腰背痛,1例随访71个月时出现相邻融合节段腰椎弓峡部裂。结论蛋壳技术联合多椎板切除钉棒系统内固定治疗成人先天性脊柱畸形是一种较安全有效的治疗方法。Objective To investigate the feasibility and safety of the treatment of congenital spinal deformity in adults with eggshell procedure combined with multi-segmental laminectomy. Methods 13 patients who underwent surgery for congenital spinal deformity in adults were retrospectively reviewed. A posterior medial incision was made for spinal exposure. According to the preoperative plan, all patients were operated with transpedicular eggshell procedure in apex vertebra and multi-segmental laminectomy to the adjacent apex vertebra. Application technique of translation, derotation with pressurized on convex side and concave side braced was used to correct scoliosis, and the autograft and allogeneic bone grafting for posterolateral spinal fusion. Results The number of vertebral lamina removed was 36 in all. The number of vertebrae with eggshell procedure was 16 in all. Fusion extent were range 8 - 15. Mean operating time was （305.4±62） minutes （range 230 ±430）, with a blood loss of （2 646 ±651） ml （1 800 ± 3 900）. The mean followed up duration was （43.5 ±7. 6） months （range 18 ± 82）. The scoliosis was 49. 2% correction at the most recent follow-up, and the kyphosis was 48. 8% correction. The following complications were encountered in 3 patients： one was cerebrospinal fluid fistula after surgery, one was a little lower back pain at the most recent followup, and one was spondylolysis of lumbar spine at 71 months after surgery. There were no other complications, such as pedicle screw breakage, pedicle screw loosing, and rob breakage. Conclusions Eggshell procedure combined with multi-segmental laminectomy is an effective alternative for the management of congenital spinal deformity in adults.

关 键 词：脊柱畸形 蛋壳技术 椎板切除术 内固定 

分 类 号：R682.13[医药卫生—骨科学] R687.32[医药卫生—外科学]