后路楔形截骨选择性钉棒矫形内固定治疗青少年先天性脊柱侧弯  

Spinal wedge osteotomy and selective screw orthopedic by simple posterior approach for correction of congenital scoliosis

作　　者：程昌志[1] 李贵谦[1] 何少康[1] 林舟丹[1] 

机构地区：[1]解放军第303医院骨科,南宁市530021

出　　处：《实用医学杂志》2013年第22期3730-3733,共4页The Journal of Practical Medicine

基　　金：广西壮族自治区自然科学基金项目(编号:桂科自0991287)

摘　　要：目的：总结单纯后路半椎体楔形截骨、选择性单侧椎弓根、凹凸侧交错置钉、钉棒系统矫形内固定治疗青少年先天性脊柱侧弯的优缺点，探讨最佳手术治疗方法。方法：2005年7月至2010年6月，对12例青少年先天性脊柱侧弯病例采用单纯经后路半椎体楔形截骨、选择性单侧椎弓根、凹凸侧交错置钉、钉棒系统矫形内固定术进行矫形治疗．男3倒，女9例；年龄11—17岁，平均14岁。胸腰段侧弯畸形8例，单纯胸段侧弯畸形2例，单纯腰段侧弯畸形2例，其中1例合并明显后凸畸形，Cobb角48°。脊柱侧凸主弯Cobb角最大75°，最小45°，平均54°，所有侧弯均合并明显旋转畸形。结果：手术时间平均276min，术中出血平均2212mL。术中固定螺钉5～8枚，平均7枚。术后12例均获随访，随访时间2～5年，平均2年3个月。术后脊柱侧凸主弯Cobb角最大32°，最小20°，平均26°，平均矫正率51．9％；1例后凸矫正后Cobb角21°，矫正率56.3％：身高增加平均2.8cm；住院费用平均46945元。结论：采用单纯后路半椎体楔形截骨、选择性单侧椎弓根、凹凸侧交错置钉、钉棒系统矫形内固定治疗青少年先天性脊柱侧弯是一种安全可靠、经济适用的方法．效果良好．适合于普通医院开展。Objective To compare the advantages and disadvantages of selective spinal wedge osteotomy and orthopedic by simple posterior approaeh for congenital scoliosis correction, and to investigate the optimal surgical methods. Methods From July 2005 to June 2010, 12 patients with congenital scoliosis received selective spinal wedge osteotomy and orthopedic by simple posterior approach, including 8 thoracolumbar scoliosis,2 thoracie scoliosis and 2 lumbar scoliosis. All patients had varying degrees of kyphosis and rotation. Before operation, the average Cobb＇s angle of scoliosis was 54°（range, 45-75 degrees）. Results The average operation period was 276 minutes and the average blood loss was 2212 mL. The average quantity of pedicle screw was 7, ranging from 5 to 8. The follow-up period ranged from 2 to 5 years with an average of 2 years and 3 months. The postoperative average Cobb＇s angle of scoliosis was 26° （range, 20-32 degrees） .The average correction rate was 51.9%. The increased at average height was 2.8 cm （range, 2.3-4.5 cm）. Conclusion Spinal wedge osteotomy and selective screw orthopedic by simple posterior approach are reliable, safe and affordable surgical techniques for congenital scoliosis correction. It＇s special applicable for low-income patients and ordinary hospital.

关 键 词：脊柱弯曲 后路楔形截骨 钉棒内固定 

分 类 号：R687.3[医药卫生—骨科学]