复杂性重度脊柱畸形 我们应该关注什么?  

What should be cared about in the management of complex severe spinal deformity?

作　　者：郑召民[1] 王华锋[1] 刘辉[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州510080

出　　处：《中国骨与关节杂志》2014年第12期886-889,共4页Chinese Journal of Bone and Joint

摘　　要：重度脊柱畸形的定义目前仍存在分歧，过去一般认为脊柱侧凸Cobb’s角〉80°即为重度脊柱侧凸，如果同时合并凸侧Bending像上柔韧性90°～100°，伴或不伴脊柱后凸畸形[2-3]。笔者认为，一味强调畸形角度的大小有失偏颇，而应该全面关注畸形的程度、僵硬度、心肺功能及营养状况、既往治疗史以及伴随的椎管内脊髓病变，将其定义为重度复杂脊柱畸形可能更为恰当。20世纪70、80年代，欧美国家的一些学者开始关注重度脊柱畸形，并发表了一系列相关研究[4-8]。然而，随着对畸形早期治疗的重视，欧美国家的重度脊柱畸形患者逐渐减少。相反，诸如中国等发展中国家，由于经济和医疗体制原因，部分脊柱畸形患者，尤其是早发型脊柱侧凸（ early onset scoliosis，EOS ）早期未能得到恰当处理，使得目前有一大批重度脊柱畸形患者急需诊治。对于我国脊柱外科医生而言，重度脊柱畸形的处理面临巨大挑战，其在诸多方面尚存不少问题，值得关注。重度脊柱畸形的处理是当前脊柱外科的难点，其围手术期处理、治疗方式的选择以及预后仍存在诸多争议，笔者结合自己有限的临床实践，就相关问题谈谈个人的粗浅看法，以供同道参考。Severe spinal deformity is not an uncommon condition that often arises from untreated early onset scoliosis in developing countries. Patients most often present with severe clinical and radiographic deformity with poor pulmonary function. Previous literature has identiifed the challenges in the treatment of these patients and the higher risk for complications. An assessment of the preoperative, intraoperative, and postoperative factors leading to an optimal result was warranted. The early evaluation should include a multidisciplinary approach from orthopaedic surgeon, pulmonologist, anesthesiologist, and perhaps neurologist to provide a baseline assessment. Advanced imaging of the spine is useful and important. Current surgical strategies include aggressive anterior and posterior column release and osteotomies, either with a front–back or a posterior-only approach. With the extent of the surgical release and segmental instrumentation, the potential for curve correction is increased;however, so is the potential for neurologic compromise. Therefore, perioperative Halo traction is recommended. It is thought to improve both spinal deformity and pulmonary function and is a helpful adjuvant in the treatment of severe spinal deformity. Improvement in the clinical and radiographic appearance, pulmonary function, and self-image is often dramatic. Proper planning and execution of the correct surgical procedure for the surgeon provides an outstanding life-changing result in these patients.

关 键 词：复杂脊柱畸形 复杂性 重度脊柱侧凸 发展中国家 脊柱后凸畸形 围手术期处理 欧美国家 早期治疗 

分 类 号：R682.3[医药卫生—骨科学]