经后路多点锚定技术治疗Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的临床疗效  

Posterior surgical correction of dystrophic scoliosis with neurofibromatosis type-1 using multiple anchor points method

作　　者：邓盎[1] 张宏其[1] 郭超峰[1] 唐明星[1] 刘少华[1] 王昱翔[1] 高琪乐[1] 吴建煌[1] 刘金洋[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,湘雅脊柱外科中心,长沙市410008

出　　处：《中国矫形外科杂志》2015年第13期1153-1158,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81271940);国家自然科学基金项目(编号:81472145);湖南省自然科学基金项目(编号:12JJ2043);湖南省“芙蓉学者计划”项目资助

摘　　要：[目的]探讨经后路多点锚定技术治疗Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的临床疗效。[方法]回顾性研究2005年1月～2013年12月本科收治的Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸23例;年龄10～22岁,平均13.6岁;其中胸弯13例,胸腰双主弯4例,胸腰弯3例,双胸弯2例,腰弯1例;术前冠状面Cobb角48.9°～91.4°,平均68.3°;凸侧Bending相Cobb角40°～79.2°,平均57.4°;柔韧性8.3%～28.1%,平均15.7%;顶椎旋转度2°～3°,平均2.3°;矢状面胸椎后凸Cobb角46.4°～79.6°,平均58.2°,胸腰段后凸Cobb角21.1°～35.7°,平均28.3°。均采用经后路多点锚定技术进行矫形融合固定。[结果]随访12～96个月,平均52个月。术后冠状面Cobb角16.3°～46.7°,平均28.4°;顶椎旋转度1°～2°,平均1.2°;矢状面胸椎后凸Cobb角16.1°～38.3°,平均25.3°,胸腰段后凸Cobb角-4.3°～18.7°,平均8.9°;术后各指标均获得良好的矫正,侧凸矫正率为46.3%～74.1%,平均56.9%。末次随访时侧凸矫正丢失率仅3.1%,无神经系统并发症,仅1例假关节形成。[结论]经后路多点锚定技术治疗Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸可获得较满意的矫形融合效果。[Objective] To study the clinical efficacy of posterior surgical correction of dystrophic scoliosis with neurofibromatosis type- 1 using multiple anchor points method. [Methods] From January 2005 to December 2013,23 patients suffering from dystrophic scoliosis with neurofibromatosis type- 1 were enrolled in this study. Their mean age was 13. 6 years old（ range,10 to 22）,13 cases with main thoracic curve,4 cases with double major curve,3 cases with thoracolumbar curve,2 cases with double thoracic curve, and 1 case with lumbar curve. The mean preoperative coronary Cobb angle was 68. 3°（ range,48. 9°to 91. 4°）,mean Cobb angle on the bending radiograph of the convex side was 57. 4°（ range,40° to 79. 2°）,mean flexibility was 15. 7%（ range,8. 3% to 28. 1%）; mean apical vertebral rotation was 2. 3°（ range,2° to 3°）,mean sagittal thoracic kyphosis angle was 58. 2°（ range,46. 4°to 79. 6°）,mean thoracolumbar kyphosis angle was 28. 3°（ range,21. 1°to35. 7°）. All cases underwent posterior surgical correction using multiple anchor points method. [Results] The mean follow-up period was 52 months（ range,12 to 96 months）. The mean postoperative coronary Cobb angle was 28. 4°（ range,16. 3°to46. 7°）,mean apical vertebral rotation was 1. 2°（ range,1°to 2°）,mean sagittal thoracic kyphosis angle was 25. 3°（ range,16. 1° to 38. 3°）,mean thoracolumbar kyphosis angle was 8. 9°（ range,- 4. 3°to 18. 7°）. All indexes showed good improvement. The mean postoperative correction rate was 56. 9%（ range,46. 3% to 74. 1%）. At final follow up,the mean corrective loss rate was only 3. 1%,there were no case of nervous system complications,and only 1 case suffered from pseudarthrosis. [Conclusion] The clinical efficacy of posterior surgical correction of dystrophic scoliosis with neurofibromatosis type- 1 using multiple anchor points method is satisfactory.

关 键 词：神经纤维瘤病 营养不良性脊柱侧凸 锚定法 后路 

分 类 号：R687.3[医药卫生—骨科学]