脊柱后路去松质骨截骨术在脊柱畸形翻修手术中的临床应用  

Clinical application of vertebral column decancellation to cancellous bone in the spinal deformity revision surgery

作　　者：朱明喜[1] 

机构地区：[1]河南中医药大学第三附属医院,河南郑州450008

出　　处：《颈腰痛杂志》2017年第5期455-459,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨脊柱畸形翻修手术中,应用后路去松质骨截骨术(vertebral column decancellation,VCD)的临床效果。方法回顾性分析了2011-2014年采用VCD截骨术进行的17例脊柱畸形返修手术患者临床资料,其中后凸畸形8例,侧后凸畸形7例,侧凸畸形2例。结果(1)17例患者均顺利完成手术,手术时间为4.1-6.3 h,平均(5.2±0.6)h;术中出血量为620-1290ml,平均(823.7±142.6)ml;住院时间为12-17 d,平均(14.1±2.3)d。(2)影像学指标变化:术后7 d,冠状面的Cobb角、双肩相对高度差、顶椎偏距,以及矢状面的Cobb角、胸腰段后凸角、腰前凸角、骶骨倾斜角、矢状面偏距、骨盆倾斜角等与术前比较,均有显著改善(P<0.05);且末次随访时与术后7 d相比,无明显差异(P>0.05)。(3)所有患者植骨融合部位均获得良好融合,生活质量量有明显改善。结论 VCD技术可有效恢复脊柱的平衡与稳定,获得较佳的三维矫形效果,同时降低了术中神经损伤的发生率,减少了出血量,值得在脊柱畸形的矫正手术与翻修手术中开展应用。Objective To investigate the clinical effect of vertebral column decancellation （VCD） in spinal deformity revision surgery. Methods The clinical data of 17 cases with spinal deformity repair surgery who were treated by VCD during 2011-2014 were retrospectively analyzed, including kyphosis in 8 cases, 7 cases of posterior kyphosis, scoliosis in 2 cases. Results （1） 17 patients were successfully completed the operation, the operation time was 4.1-6.3 h, average （5.2＋0.6） h; the intraoperative bleeding was 620-1290 ml, average （823.7＋142.6） ml; the hospitalization time was 12- 17 days, average （14.1＋2.3） days. （2） Imaging index changes： 7 d after the operation, the coronal Cobb angle, shoulders, the relative height difference of the apical vertebra translation, and sagittal Cobb angle, thoracolumbar kyphosis, lumbar lordosis and sacral inclination angle, sagittal offset and pelvic tilt angle were significantly improved compared with preoperation （P〈0.05）. There were no significant differences at last follow-up and postoperative 7 days （P〉0.05）. （3） All patients had good fusion of bone graft, and the quality of life improved significantly. Conclusion The balance and stability of VCD technology can effectively restore the spinal three-dimensional orthopedic, obtain better results, while reduce the incidence of intraoperative nerve injury, reduce the amount of bleeding, it is worthy of application in the spinal deformity correction surgery and revision surgery.

关 键 词：脊柱畸形 翻修手术 后路去松质骨截骨术 

分 类 号：R687.3[医药卫生—骨科学]