单纯后路矫形治疗先天性脊柱侧凸合并Ⅰ型脊髓纵裂畸形  

Posterior corrective surgery without resection of ossseus septum for the treatment of congenital scoliosis associated with type Ⅰ split cord malformation

作　　者：夏青 孙建民[2] 

机构地区：[1]枣庄矿业集团中心医院骨科,山东277011 [2]山东大学附属山东省立医院脊柱外科,济南250021

出　　处：《中国骨科临床与基础研究杂志》2017年第3期146-154,共9页Chinese Orthopaedic Journal of Clinical and Basic Research

摘　　要：目的探讨单纯后路截骨矫形治疗先天性脊柱侧凸合并Ⅰ型脊髓纵裂畸形的安全性和临床效果。方法回顾性分析2005年3月至2015年9月收治的10例先天性脊柱侧凸合并Ⅰ型脊髓纵裂畸形患者的临床资料,均不处理骨性纵隔,单纯经后路截骨进行矫形。通过记录手术时间、术中失血量和输血量、围手术期神经功能变化及并发症来评估手术的安全性,根据手术前后脊柱侧凸冠状面Cobb角、顶椎偏距、胸廓躯干偏移和躯干平衡等客观矫形指标及脊柱侧凸研究学会(SRS)-30评分来评估手术的有效性。结果患者获得3~36个月随访(平均14.2个月)。平均手术时间、术中失血量及术中输血量分别为275.4 min、4 005.7 m L和2 800 m L;围手术期并发症包括脑脊液漏1例、胸腔积液10例、切口感染1例、下肢神经功能症状加重6例(其中5例治疗后恢复至术前水平、1例遗留永久性足下垂)。术后大体外观均显著改善;术后及末次随访时影像学测量参数均较术前明显改善(P<0.05),末次随访时矫正率虽较术后即刻有所丢失,但总体矫形效果满意;末次随访SRS-30自我形象、心理健康评分以及总评分均优于术前,手术前后比较,差异有统计学意义(P<0.05)。结论对于合并Ⅰ型脊髓纵裂畸形的先天性脊柱侧凸患者,采取不预先处理骨性纵隔的单纯经后路截骨治疗矫形效果满意,但具有一定的手术风险,需严格掌握适应证。Objective To explore the safety and the efficacy of surgical correction by posterior osteotomy without resection of osseus septum for the treatment of congenital scoliosis with type I split cord malformation （SCM）. Methods Clinical data of 10 patients with congenital scoliosis complicated with type I SCM treated from March 2005 to September 2015 were retrospectively analyzed. All of them underwent posterior osteotomy correction without resection of bony septum. The operative time, intraoperative estimate blood loss and transfusion volume, perioperative nerve functions and complications were recorded to evaluate the safety of corrective surgery, changes of objective correction parameters including Cobb angles in coronal plane, apical vertebral translation, trunk shift and trunk balance were measured preoperatively and postoperatively to observe the surgical efficacy. Results All patients were followed up for 14.2 months （range from 3 to 36 months）. Average operative time, intraoperative estimate blood loss and transfusion volume were respectively 275.4 min, 4 005.7 mL and 2 800 mL. There were 1 case of cerebrospinal fluid leakage, 10 cases of pleural effusion, 1 case of surgical site infection; Worsen neurological symptoms in lower limbs were found in 6 patients after the surgery, in which 5 patients recovered after the treatment, while 1 case remained permanent foot drop. After the surgery, general appearance of patients improved obviously; Radiologieal parameters measured at the postoperative and the last follow-up all improved significantly compared with the preoperative ones （P 〈0.05）, The correction rate at the latest follow-up were lower than those at the postoperation, but the total correction effect was satisfactory; At the last follow-up, SRS-30 scores in body image and mental health items, as well as total scores were all higher than those at the preoperation, the differences had statistical significance （P 〈0.05）. Conclusion For patients with congenital scoliosis complicated with typ

关 键 词：脊柱侧凸 脊髓纵裂畸形 矫形外科手术 截骨术 纵隔 

分 类 号：R687.3[医药卫生—骨科学]