蛋壳技术联合后路短节段固定矫治进展性半椎体畸形  

Egg-shell technology and posterior short-segment transpedicular instrumentation correcting for progressive kyphoscoliosis caused by hemivertebra

作　　者：勾瑞恩[1] 崔京福 刘纪恩[1] 母心灵[1] 

机构地区：[1]郑州市第一人民医院脊柱外科,郑州450004

出　　处：《医药论坛杂志》2017年第10期66-69,72,共5页Journal of Medical Forum

摘　　要：目的评估经后路蛋壳技术切除半椎体,钉棒系统短节段固定矫治进展性脊柱侧后凸的临床效果。方法回顾分析2011年6月至2014年6月郑州市第一人民医院收治的完全分节性半椎体引起的进展性脊柱侧后凸患者19例,其中男8例,女11例,年龄6.2~11.7岁,平均8.2岁。取后正中切口,应用蛋壳技术切除半椎体,椎弓根钉棒系统固定临近节段,术后佩戴支具3个月;比较术前术后全主弯角度、头侧代偿弯角度、尾侧代偿弯角度,半椎体节段侧弯角、半椎体节段后凸角、计算矫正率。结果手术时间150~450 min,平均(198±21)min;术中出血量200~1 000 m L,平均(600±120)m L。术中1例患者现椎弓根切割,经重新调整,于上位椎体椎弓根置钉加压,短节段固定,矫形效果满意,术后未见明显并发症,末次随访矫形未见明显丢失。19例半椎体畸形患儿术后随访2年主弯冠状面Cobb角矫正率69.7%,头侧代偿弯Cobb角矫正率74.3%,尾侧代偿弯Cobb角矫正率69.4%,半椎体节段侧弯Cobb角矫正率58.9%,半椎体节段后凸Cobb角矫正率131.6%。与术前比较差异有统计学意义(P<0.05);与术后1周的影像学指标比较差异无统计学意义(P>0.05)。结论先天性脊柱侧后凸尚未固化时,经后路蛋壳技术切除半椎体,钉棒系统短节段固定矫治先天性脊柱侧后凸效果满意。Objective To evaluate the clinical effects ofposterior hemivertebra resection via egg-shell technology forprogressive kyphoscoliosis and the nearby vertebras were shortsegment correction with pedicle screw and rod system. Methods All cases were analyzed retrospectively. From June 2011 to June 2014,19 progressive kyphoscoliotic cases caused by fully segmented hemivertebra were treated in our department. There were 8 males and 11 females among them,the average age was 8. 2 years old. The hemivertebras were resected through posterior middle approach and egg-shell technology. The nearby stage were fixed by pedicle screw and rod system. Postoperative external support was attached for more than 3 months. Standing anteroposterior and lateral radiographs were compared at preoperative and postoperative stage and were reviewed to determinethe main bending coronal Cobb angle,compensatory head side Cobb angle,compensatory caudal curve Cobb angle,segmental scoliosisangle,segmental kyphosis angle and correction rates were calculated. Results The operation time was 150 ~ 450 minutes,average（ 198± 21） minutes. The blood loss was 200-1000 m L,mean（ 600±120） ml. One vertebral pedicle damaged during operations and the pedicle screw was replaced on the superior vertebrae and shortsegment correction were fixed once again. There were no major complications and no neurologic damage were found post-operation and the kyphoscoliosis was no recurrence at latest follow-up. Two years later of post-operation,the correction rates of the the main bending coronal Cobb angle was 69. 7%,compensatory head side Cobb angle was74. 3%,compensatory caudal curve Cobb angle was 69. 4%,segmental scoliosisangle was 58. 9%,segmental kyphosis angle was 131. 6%. Comparison between pre-operation and post-operation showed significant difference（ P〈0. 05）,but comparison between immediate postoperation and two years later of postoperation showed no significant difference（ P〈0. 05）. Conclusion When congenital kyphoscoliosis was non-structural,

关 键 词：半椎体 蛋壳技术 短节段固定 

分 类 号：R682.3[医药卫生—骨科学]