一期经后路半椎体切除短节段固定矫治先天性脊柱半椎体畸形  

One-stage posterior hemivertebra resection and short segmental instrumentation fixation and fusion in the treatment of congenital kyphoscoliosis

作　　者：张强[1] 邹传奇 陈振强[1] 初同伟[3] 吕甲涛 肖以磊[5] 

机构地区：[1]山东省聊城市人民医院骨科,252000 [2]重庆市第三军医大学附属新桥医院急诊科,404100 [3]重庆市第三军医大学附属新桥医院骨科,404100 [4]山东省聊城市人民医院骨神经外科,252000 [5]山东省聊城市人民医院神经外科,252000

出　　处：《中华临床医师杂志（电子版）》2016年第9期62-65,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的评估一期经后路半椎体切除短节段固定近远期手术疗效,探讨采用短节段固定融合的手术适应证及并发症。方法 2008年7月至2013年2月聊城市人民医院骨科共采用经后路半椎体切除短节段固定融合术20例,此类手术患者术前、术后及随访时均拍摄脊柱正、侧位X线片,并测量半椎体所致侧凸cobb角、后凸cobb角,C7PL-CSVL;分别计算其改善率;记录围手术期及远期并发症。结果手术时间1.75~5.33 h,平均3.15 h,术中出血量80~1 200 ml,平均597.5 ml。全部病例随访13~61个月,平均43.4个月。侧凸cobb角术后即刻矫正率（70.00±23.04）%,末次随访矫正率（65.38±21.54）%;后凸cobb角术后即刻矫正率（69.00±19.39）%,末次随访矫正率（56.86±11.88）%。所有病例围手术期均无神经系统并发症发生,无伤口愈合不良、椎弓根切割、钉棒断裂等,1例患者因植骨未融合,后凸畸形加重,通过二次手术延长固定节段,畸形得以矫正。末次随访时所有病例均未见假关节形成或其他并发症。结论对于半椎体所致的先天性脊柱侧后凸畸形,采用一期经后路半椎体切除植骨融合内固定术是安全有效的;当患儿年龄小,脊柱柔韧性好,代偿弯为非结构性代偿弯时,可采用短节段固定融合术。Objective To evaluate the outcomes of surgical treatment for congenital spinal deformity and study the surgical orientation by segmental fusion combine with posterior instrumentation and complications. Methods From July 2008 to February 2013, there were 20 cases of surgical treatment in Liaocheng People＇s Hospital, long cassette standing radiographs were taken before and after surgery and at the final follow-up. Scoliosis, kyphosis, C7PL-CSVL were measured preoperatively and immediately postoperatively as well as at the latest follow-up. Calculated the improvement rate separately, and record the perioperative and long-term complications. Results The average operative time was 3.15 hours with a mean 597.5 ml of blood loss. The average follow-up was 43.4 months ranging from 13 to 61 months. The scoliosis correction rate was（70.00±23.04）% after surgery, and（65.38±21.54）% at latest follow-up. The kyphosis correction rate was（69.00±19.39）% after surgery and（56.86±11.88）% at latest follow-up. There were no major complications and no neurologic damage. Bone graft unfusion in 1 case, through the second operation, to extend the fixed section, dramatically correct deformity. Conclusions Posterior hemivertebra resection and internal fixation is a safe and reasonable surgical option for congenital or kyphosis deformity. For the young cases with non-structural curve should use a short segment fixation.

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 短节段固定 

分 类 号：R687.3[医药卫生—骨科学]