后路经顶椎楔形截骨矫形治疗重度僵硬性特发性脊柱侧凸  

Spinal posterior wedge osteotomy for correction of severe rigid idiopathic scoliosis

作　　者：徐韬[1] 郭海龙[1] 买尔旦·买买提[1] 普拉提·买买提[1] 盛军[1] 邓强[1] 盛伟斌[1] 

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054

出　　处：《中华解剖与临床杂志》2014年第4期285-289,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的：评价后路经顶椎楔形截骨治疗重度僵硬性特发性脊柱侧凸的疗效及安全性。方法回顾性分析1998年9月-2012年12月收治的17例重度僵硬性特发性脊柱侧凸患者的临床资料,其中男5例,女12例；年龄14~24岁,平均18.6岁；LenkeⅡ型3例,Ⅲ型4例,Ⅳ型4例,Ⅵ型6例。均行后路经顶椎楔形截骨矫形固定融合术。术前、术后及随访时拍摄站立位全脊柱X线片,测量冠状面、矢状面侧凸Cobb角及躯干矢状面偏移距离,记录脊柱融合固定节段和融合情况。结果均获得随访12~84个月,平均47.6个月。融合固定节段为11~16节椎体,平均14节。末次随访冠状面Cobb角由术前平均102.2°,矫正至39.4°,矫正率为61.4%；矢状面Cobb角由术前平均49.5°,矫正至8.6°,矫正率为82.6%；躯干冠状偏移距离由术前平均-29.8 mm,矫正至-3.5 mm,平均矫正26 mm。围手术期并发症主要包括胸膜破裂4例,胃肠道功能紊乱2例。结论对重度僵硬性特发性脊柱侧凸采取后路经顶椎楔形截骨矫形及内固定是较为安全、有效的方法。Objective To evaluate the efficacy and safety of spinal posterior wedge osteotomy for correction of severe rigid idiopathic scoliosis. Methods Seventeen consecutive cases with severe rigid idiopathic scoliosis were treated by spinal posterior wedge osteotomy. There were 5 males and 12 females, and the average age was 18. 6 years（14-24 years）. The Lenke classification involved 3 cases in LenkeⅡ, 4 cases in Lenke Ⅲ, 4 cases in Lenke Ⅳ, 6 cases in Lenke Ⅵ. The coronal and sagittal Cobb′s angles, sagittal trunk shifts, and fusion segments were measured on standing AP and lateral radiographs before, after surgery and the final follow-up. Results The average follow-up was 47. 6 months（12-84 months）. The Cobb′s angle in the coronal plane was corrected from 102. 2° to 39. 4°, the correction rate was 61. 4%. The Cobb′s angle in the sagittal plane was corrected from 49. 5° to 8. 6°, the correction rate was 82. 6%. Coronal trunk shift was obviously improved from -29. 8 mm to -3. 5 mm. The average fusion segments were 14, ranging from 11 to 16. Perioperative complications consisted of pleura injury in 4 cases, and gastrointestinal dysfunction in 2 cases. Conclusions Spinal wedge osteotomy correction by the single posterior approach is a reliable and safe surgical technique for correction of severe rigid idiopathic scoliosis.

关 键 词：脊柱侧凸 特发性 僵硬性 截骨术 

分 类 号：R687.3[医药卫生—骨科学] R726.8[医药卫生—外科学]