顶椎楔形截骨术治疗重度僵硬型脊柱侧后凸畸形  

Transpedicular wedge osteotomy of apical vertebrae for treatment of severe rigid kyphoscoliosis

作　　者：华文彬[1] 杨操[1] 郜勇[1] 张宇坤[1] 吴星火[1] 李帅[1] 王琨[1] 杨述华[1] 邵增务[1] HUA Wen-bin;YANG Cao;GAO Yong;ZHANG Yu-kun;WU Xing-huo;LI Shuai;WANG Kun;YANG Shu-hua;SHAO Zeng-wu(Department of Orthopaedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,湖北430022

出　　处：《脊柱外科杂志》2018年第6期331-336,共6页Journal of Spinal Surgery

摘　　要：目的探讨顶椎楔形截骨术治疗重度僵硬型脊柱侧后凸畸形的临床疗效。方法 2012年5月—2014年10月,采用经后路顶椎楔形截骨术治疗的23例重度僵硬型脊柱侧后凸畸形患者,其中9例为特发性,14例为先天性,侧凸及后凸顶椎均位于同一节段。术前、术后及随访期间分别拍摄站立位脊柱全长正侧位X线片,测量侧凸及后凸Cobb角,评价矫形效果;采用SRS-22问卷评分评定日常生活能力。结果手术时间270～570 min,平均387 min;术中出血量900～2 700 mL,平均1 701 mL。所有患者随访> 24个月。侧凸Cobb角术前110.6°±23.4°,术后24个月41.4°±12.0°,矫正率为62.6%。后凸Cobb角术前91.5°±27.8°,术后24个月33.1°±14.7°,矫正率为63.8%。冠状面偏移术前(30.3±17.0)mm,术后24个月(19.6±15.1)mm;矢状面偏移术前(34.0±42.2)mm,术后24个月(10.3±15.9)mm。术后24个月SRS-22问卷各项得分及总分与术前相比均显著改善。所有患者术后12个月截骨部位均获得骨性融合。1例患者术后由于痰液阻塞出现肺不张,8例胸腔积液。1例发生神经系统并发症,术后3个月神经功能恢复至术前水平。结论顶椎楔形截骨术治疗重度僵硬型脊柱侧后凸畸形,矫形效果良好,能够实现冠状面和矢状面平衡的重建。Objective To evaluate the clinical outcomes of transpedicular wedge osteotomy of the apical vertebrae in patientswith severe rigid kyphoscoliosis.Methods From May2012to October2014,23patients with severe rigid kyphoscoliosiswere treated by transpedicular wedge osteotomy of the apical vertebrae via posterior approach.Nine patients had a diagnosis ofidiopathic kyphoscoliosis and the other14patients had a diagnosis of congenital kyphoscoliosis.The apical vertebrae of scoliosisand kyphosis were all in the same segment.Preoperative and postoperative scoliosis and kyphosis Cobb's angle were measuredand compared.The SRS-22questionnaire was used to evaluate the health-related quality of life.Results The operation time was270-570min with an average of387min,and the intraoperative blood loss was900-2700mL with an average of1701mL.Allthe patients were followed up for more than24months.The scoliosis Cobb's angle improved from preoperative110.6°±23.4°to postoperative24months41.4°±12.0°,with a correction rate of62.6%.The kyphosis Cobb's angle was improved frompreoperative91.5°±27.8°to postoperative24months33.1°±14.7°,with a correction rate of63.8%.The coronal misregistrationwas improved from preoperative(30.3±17.0)mm to postoperative24months'(19.6±15.1)mm.The sagittal misregistrationwas improved from preoperative(34.0±42.2)mm to postoperative24months'(10.3±15.9)mm.Postoperative scores ofSRS-22questionnaire were all improved significantly compared with preoperative scores.Bony fusion of the osteotomy wasachieved by postoperative12months.One case suffered from pulmonary atelectasis because of obstruction of thick sputum,and8cases suffered pleural effusion.Transient,unilateral leg paresis was observed in only1case,with recovery of neurologicalfunction at postoperative3months.Conclusion Transpedicular wedge osteotomy at the apical vertebrae is effective in thetreatment of severe rigid kyphosis.It can achieve the reconstruction of coronal and sagittal balances.

关 键 词：胸椎 腰椎 脊柱侧凸 脊柱后凸 截骨术 

分 类 号：R682.3[医药卫生—骨科学]