后路一期全脊椎切除治疗严重、僵硬先天性脊柱侧后凸/后凸畸形  

Efficacy and complications of posterior-only vertebral column resection for severe congenital kyphoscoliosis/kyphosis

作　　者：郑毅全[1] 仉建国[2] 王升儒[2] 郭建伟[3] 张延斌[2] 杨阳[2] 林莞锋 

机构地区：[1]福建医科大学附属漳州市医院骨科,福建漳州363000 [2]中国医学科学院北京协和医学院北京协和医院骨科,北京100730 [3]青岛大学附属医院骨科,山东青岛266003

出　　处：《中国骨与关节外科》2016年第5期371-375,385,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：严重、僵硬先天性脊柱侧后凸／后凸畸形需外科手术干预，已有文献报道使用多种外科术式治疗。后路一期全脊椎切除术（Posterior-only vertebral column resection，PVCR）治疗严重脊柱畸形的文献报告中，病例的病因组成混杂，目前尚无针对PVCR治疗严重、僵硬先天性脊柱侧后凸／后凸畸形的大宗病例报道。目的：探讨PVCR治疗严重、僵硬先天性脊柱侧后凸／后凸畸形的疗效、并发症及预防措施。方法：回顾性分析2004年1月至2012年1月于北京协和医院接受PVCR治疗的66例严重脊柱侧后凸／后凸患者的临床资料，男33例，女33例；年龄2-49岁，平均（16．0±2.3）岁；包括先天性脊柱侧后凸36例，先天性脊柱后凸30例。所有患者均采用全椎弓根螺钉技术，其中翻修手术8例。10例患者存在椎管内畸形。通过站立位全脊柱正侧位X线片测量手术前后冠状面和矢状面节段性Cobb角、躯干偏移（Trunk shifl，TS）以及矢状面平衡（Sagittal vertical axis，SVA）情况，同时记录围手术期以及迟发并发症情况。结果：平均切除椎体（1．5±0．7）个（1～3个），手术时间195～540min，平均（330±44）min；出血量250-3000ml，平均（1171±387）ml。所有患者均获得随访，随访时间24～129个月，平均（55．5±7．4）个月。侧后凸组的冠状面侧凸、矢状面后凸、TS、SVA、胸后凸、腰前凸，和后凸组的矢状面后凸、SVA、胸后凸、腰前凸均得到明显改善。共12例患者发生并发症，其中不完全脊髓损伤2例，一过性神经根损伤1例，近端交界性后凸1例，内固定失败4例，血胸2例，术中硬膜撕裂4例，脑脊液漏l例。结论：PVCR是治疗严重、僵硬先天性脊柱侧后凸／后凸畸形的有效手段，其矫形效果良好。对于角状畸形而言，常需1个节段以上的脊椎切除。该手术技术要求高，且有一定的并发症发生率，内固�Background： Many surgical procedures have been introduced to treat severe congenital kyphoscoliosis/kyphosis. Posterior-only vertebral column resection （PVCR） has been proved to be an ideal procedure for severe angular spinal defor- mities. However, the patients in previous studies on PVCR were heterogeneous, including idiopathic, post-infectious, neuro- muscular and congenital scoliosis or kyphoscoliosis. Objective： To retrospectively evaluate the efficacy and safety of PVCR for severe congenital kyphoscoliosis/kyphosis. Methods： In this study, 66 patients （36 angular congenital kyphoscoliosis and 30 kyphosis） undergoing PVCR in Peking Union Medical College Hospital between January 2004 and January 2012 were retrospectively analyzed. There were 33 males and 33 females with an average age of （16.0±2.3） years （range, 2-49 years）. Revision was performed in 8 patients. Intra-spinal anomalies were found in 10 patients. The patients＇ radiograghs and hospi- tal records were reviewed. Deformity in sagittal planes and global sagittal alignment were analyzed for correction and main- tenance of the correction in preoperative, postoperative, and follow-up radiographs. The complications and related risk fac- tors were analyzed. Results： The mean number of vertebrae excised was 1.5±0.7 （range, 1-3）. The mean operation time was （330±44） min （range, 190-540 min）. The mean blood loss was （1171±387） ml （range, 250-3000 ml）. The mean follow-up was 55.5±7.4 months （range, 24-129 months） in all the patients. The segmental scoliosis, segmental kyphosis, trunk shift, and sagittal vertical axis were improved after the surgery in the kyphoscoliosis group. And in the kyphosis group, the correc-tion of segmental kyphosis and sagittal vertical axis were relatively satisfied. Complications occurred in 12 patients, includ- ing 2 incomplete spinal cord injury, 1 root injury, 1 proximal junctional kyphosis, 4 implant failures, 2 hemothorax and 4 in- traoperative subdural tear. Conclusions�

关 键 词：脊柱侧凸 手术后并发症 

分 类 号：R726.8[医药卫生—儿科]