成人重度僵硬性脊柱侧后凸合并脊髓畸形的截骨手术治疗  

Osteotomy operation in the treatment of adult severe rigid kyphoscoliosis complicated with spinal deformity

作　　者：司泽兵 吴继功[1,2] 马华松[2] 陶有平[2] 邵水霖[2] 姬勇[2] 高博[2] 李海侠[2] 张乐乐[2] 陶飞飞[2] 

机构地区：[1]安徽医科大学解放军306医院临床学院,安徽合肥230032 [2]解放军306医院骨科全军脊柱外科中心,北京100101

出　　处：《颈腰痛杂志》2015年第6期453-458,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨成人重度僵硬性脊柱侧后凸合并脊髓畸形的截骨手术治疗及早期临床疗效。方法回顾性分析2010-04-2014-04在本院接受手术治疗的18例成人重度僵硬性脊柱侧凸合并脊髓畸形患者。根据患者术前影像学中脊髓畸形特点及临床经验,采用一期骨嵴切除、终丝切断、后颅窝减压术,二期经后路全脊椎截骨治疗。记录手术时间、术中出血量,术前、术后及末次随访时的做影像学改变。结果所有患者手术均顺利进行。术后2周冠状面及矢状面主弯Cobb角、冠状面及矢状面平衡平均矫形率分别为55.4%、53.9%、58.9%、56.2%,与术前比较差异具有统计学意义(P<0.05)。平均随访16.3个月,末次随访时,冠状面及矢状面主弯Cobb角、冠状面及矢状面平衡与术后2周比较差异无统计学意义(P>0.05)。随访期间患者恢复良好,无并发症,矫形效果未见明显丢失。结论根据成人重度僵硬性脊柱侧后凸合并复杂脊髓畸形的类型和特点,一期进行脊髓畸形的处理,二期进行全脊椎截骨手术矫形,可达到满意的早期临床效果和安全性。Objective To research the therapy of osteotomy on adult severe rigid kyphoscol- iosis complicated with spinal deformity and its early clinic efficacy. Methods From April 2010 to April 2014, 18 patients in our hospital who diagnosed as severe rigid kyphoscoliosis compli- cated with spinal deformity were selected. According to the characteristics of the patients, we used underwent osseous divide cut, tethered resection, posterior fossa decompression by one- stage, then we taken posterior vertebral column resection. The time and blood loss of operation, the change of pre-operative, post-operative and last follow-up imagings were recorded. Results All of the operations were successful. We measured and recorded the data of the average cor- rection of post-operative coronal main curve Cobb angel, kyphosis main curve Cobb angel,coro- nal and kyphosis imbalance. Two weeks after the operation, the correction rates were 55.4%,53. 9%,58.9%,56.2% respectively（P〈0.05）. Compared with the data recorded, two weeks after operation, the last follow-up visit, there was no significant difference （P〉0.05）, and the follow-up visit contained 16.3 months in average. During the follow-up period, all patients were in good re- covery, effects of correction were expected, no complications were found. Conclusion According to the types and characteristics of adult severe rigid kyphoscoliosis complicated with spinal deformity, we usually manage spinal cord deformity by one-stage,then take posterior vertebral column resection, and this method can get well early clinic effect and safety.

关 键 词：重度 脊柱侧后凸 脊髓畸形 截骨 

分 类 号：R682.13[医药卫生—骨科学]