一期经后路半椎体切除手术时机的选择对脊柱矫形效果的影响  

IMPACT OF SURGICAL OPPORTUNITY ON EFFECTIVENESS OF POSTERIOR HEMIVERTEBRA RESECTION FOR CONGENITAL SPINAL DEFORMITY

作　　者：邹传奇 邱浩[1] 潘勇[1] 周跃[1] 初同伟[1] 

机构地区：[1]第三军医大学新桥医院脊柱外科,重庆400037

出　　处：《中国修复重建外科杂志》2014年第4期468-473,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 比较不同年龄段患者一期经后路半椎体切除行脊柱矫形的效果,探讨最佳手术时机的选择。方法 回顾分析2007年1月-2013年2月采用经后路半椎体切除植骨融合内固定术治疗的36例先天性脊椎半椎体畸形患者,男22例,女14例;年龄5～48岁,平均16.8岁。根据年龄分为≤10岁7例（A组）,10～20岁22例（B组）,〉20岁7例（C组）。3组患者性别、半椎体节段、类型、合并症等一般资料比较,差异均无统计学意义（P〉0.05）。术前、术后即刻及末次随访时摄脊柱正侧位X线片,测量脊柱侧凸Cobb角、后凸Cobb角、C7铅垂线（C7PL-CSVL）评估指标,并计算改善率,比较3组矫形效果;同时记录围手术期及远期并发症。结果 手术时间A组少于C组（P〈0.05）,术中出血量B、C组显著高于A组（P〈0.05）,固定节段B、C组明显多于A组（P〈0.05）。36例均获随访,随访时间7～62个月,平均31.3个月。随访期间无伤口愈合不良、椎弓根切割、钉棒断裂、假关节形成等并发症发生。末次随访时31例患者双肩、双髋达到了平衡状态。3组组内术后即刻及末次随访时侧凸Cobb角、C7PL-CSVL、后凸Cobb角均较术前显著改善（P〈0.05）。除末次随访时侧凸Cobb角B组〉C组,后凸Cobb角术后即刻矫正率A、C组〉B组,后凸Cobb角末次随访矫正率B组〈C组,C7PL-CSVL术后即刻矫正率A组〉B组,差异有统计学意义（P〈0.05）外,其余各组间比较差异均无统计学意义（P〉0.05）。结论 早期行一期经后路半椎体切除安全有效,特别是在形成结构性代偿弯及脊柱僵硬前手术治疗,可缩短手术时间,减少固定节段及术中出血,对脊柱的生长及活动度影响相对较小。Objective To investigate the optimal surgical opportunity timing of posterior hemivertebra resection by comparing the outcomes of surgical treatment for congenital spinal deformity in patients at different ages. Methods Between January 2007 and Februay 2013, 36 cases of congenital hemivertebra scoliosis underwent one-stage posterior hemivertebra resection and segmental instrumentation fLxation and fusion. There were 22 males and 14 females, with an average age of 16.8 years （range, 5-48 years）. The patients were divided into 3 groups： group A （〈~ 10 years, n=7）, group B （10-20 years, n=22）, and group C （〉 20 years, n=7）. There was no significant difference in gender, segment, type, and complication among 3 groups （P 〉 0.05）. Anteroposterior and lateral X-ray films were taken before and after operation to measure the scoliosis Cobb angle, kyphosis Cobb angle, and C7 plumb line-center sacral vertical line （C7PL-CSVL）. The improvement rate was calculated. And the perioperative and long-term complications were recorded. Results The operation time of group A was significantly less than that of group C （P 〈 0.05）; the intraoperative blood loss of group B and group C were significantly more than that of group A （P 〈 0.05）; and the fixed segments of group B and group C were significantly more than those of group A （P 〈 0.05）. Thirty-six cases were followed up 7-62 months （mean, 31.3 months）. No poor wound healing, pedicle cutting, pseudoarticulation formation, and other complications occurred during the follow-up. At last follow-up, 31 patients obtained a balance of double shoulders and double hips. The scoliosis Cobb angle, kyphosis Cobb angle, and CTPL-CSVL at immediate after operation and last follow- up were significantly improved when compared with preoperative ones in 3 groups （P 〈 0.05）. The scoliosis Cobb angle at last follow-up of group B was significantly larger than that of group C, the kyphotic correction rate at immediate after operation was signifi

关 键 词：脊柱侧凸 脊柱后凸 后路半椎体切除 植骨融合 内固定 

分 类 号：R687.3[医药卫生—骨科学]