一期后路半椎体切除加全节段椎弓根螺钉固定矫形青春期严重先天性脊柱侧后凸畸形  

Hemivertebra Resection and All Segmental Pedicle Screws Fixation by a Single Posterior Approach for Correction of Severe Adolescent Congenital Spinal Deformities

作　　者：方忠[1] 李锋[1] 熊伟[1] 廖晖[1] 李光辉[1] 方煌[1] 陈安民[1] 肖骏[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《华中科技大学学报（医学版）》2012年第5期627-630,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家"十一五"科技支撑计划资助项目(No.2007BAI04B07)

摘　　要：目的回顾分析14例青春期严重先天性脊柱侧后凸畸形采用一期后路半椎体切除加全节段椎弓根螺钉固定术治疗,探讨青春期严重先天性脊柱侧后凸畸形采取此手术的可行性和相关手术处理技巧。方法 2004年10月～2011年3月,通过一期后路半椎体切除加全节段椎弓根螺钉固定术矫治14例青春期严重先天性脊柱侧后凸畸形患者,男9例,女5例,年龄12～18岁,平均14.3岁;其中单个半椎体10例,多个半椎体2例,半椎体合并对侧骨桥或肋骨融合2例;病变位于胸段(T4、T5、T7、8、T9)4例、胸腰段(T11、T12各2例、L1、2、L2各1例)6例、腰段(L3、L4各2例)4例。术前脊柱侧凸Cobb’s角63°～105°,平均76°;脊柱后凸角42°～83°,平均56°;躯干偏移3.0～31.5mm,平均14.1mm。内固定使用CDH 3例,TSRH 9例,中华长城2例。结果全部病例随访7～72个月,平均36.4个月。手术时间147～428min,平均221min;术中出血210～1 860mL,平均860mL。固定融合节段7～13个椎体,平均9.6个。术后脊柱侧凸Cobb’s角13°～45°,平均31.2°,平均矫正率58.9%;术后脊柱后凸Cobb’s角11°～39°,平均26.5°,平均矫正率59.0%;术后躯干偏移0～10.3mm,平均为4.3mm。随访中脊柱侧、后凸和躯干偏移无明显矫正丢失。手术并发症包括术中加压时椎弓根切割1例,代偿弯加重1例,术后切口渗液1例。结论采用一期后路半椎体切除加全节段椎弓根螺钉固定矫形青春期严重先天性脊柱侧后凸是一个安全、可靠的手术方法,其矫形效果满意、固定可靠。Objective To introduce the safety of the hemivertebra resection and all segmental pedicle screws（ASPS）fixation by a single posterior approach and to discuss the selection of fusion and fixation.Methods Fourteen patients with severe adolescent congenital spinal deformities were treated by the hemivertebra resection and ASPS fixation by a single posterior approach between Oct.2004 and Mar.2011,including 9 males and 5 females with an average age of 14.3 years（range 12 to 18 years）.There were 10 patients with one hemivertebra,2 patients with multiple hemivertebre and 2 with fused ribs or bone bridge.The average Cobb＇s angles of scoliosis and kyphosis before operation were 76° and 56° respectively.The average trunk shift was 14.1 mm.Results The follow-up period ranged from 7 to 72 months with an average of 36.4 months.The operation time is 221 min（147-428 min） on average and the mean bleeding volum is 860 mL（210-1 860 mL）.The average fused vertebrae were 9.6 segments（range 7 to 13 segments）.The postoperative average Cobb＇s angles of scoliosis and kyphosis were 31.2° and 26.5° respectively.The average correction rate of scoliosis and kyphosis was 58.9% and 59.0% respectively.The average trunk shift was improved to 4.3 mm.There was no significant correction loss of the scoliosis,kyphosis or trunk shift at final follow-up evaluation.No patient developed severe complications except that one had pedicle fracture,one had the increasing curve for the compensatory curve and one had exudates of incision.Conclusion The hemivertebra resection and ASPS fixation by a single posterior approach is a reliable and safe surgical technique for correcting severe adolescent congenital spinal deformities.

关 键 词：半椎体 畸形 脊柱侧凸 脊柱后凸 固定 

分 类 号：R682.3[医药卫生—骨科学]