全脊椎切除联合钛网植骨矫正胸腰椎角状后凸  

Posterior vertebral column resection combined with titanium mesh bone grafting for severe thoracolumbar angular kyphosis

作　　者：李超[1] 于海洋[1] 付青松[1] 李海江[1] 尹稳[1] 王伟[1] 张伟[1] 邹欣欣[1] LI Chao;YU Hai-yang;FU Qing-song;LI Hai-jiang;YIN Wen;WANG Wei;ZHANG Wei;ZOU Xin-xin(Department of Orthopaedics,Fuyang Clinical College,Anhui Medical University,Fuyang 236000,China)

机构地区：[1]安徽医科大学阜阳临床学院骨科,安徽阜阳236000

出　　处：《中国矫形外科杂志》2020年第23期2179-2182,共4页Orthopedic Journal of China

基　　金：安徽省科技重点攻关项目(编号:12010402121)。

摘　　要：[目的]介绍后路全椎切除联合钛网周围植骨重建治疗重度脊柱角状后凸的手术技术与初步临床效果。[方法] 2004年2月~2015年7月,采用后路全脊椎切除钛网周围植骨治疗重度脊柱角状后凸13例。经后路显露畸形脊柱后部结构全段,于截骨远、近段分别置入椎弓根钉。松解脊柱后柱,用临时固定棒固定,以后凸顶椎为中心行楔形全椎骨切除,矫正畸形,测量脊柱缺损长度,植入填充碎骨粒及适当长度的钛网,加压闭合截骨间隙固定。[结果] 13例患者均顺利手术,无医源性血管、神经和内脏损伤。术后矢状面平均矫正率75.89%,术后冠状面平均矫正率87.01%,矢状面偏移距离平均矫正率74.88%。随访25~106个月,末次随访矢状面Cobb角矫正度无明显丢失,所有患者均达到骨性融合。[结论]后路全脊椎切除联合钛网周围植骨技术可有效矫正重度脊柱角状后凸,防止过度脊髓短缩,重建脊柱稳定性。[Objective] To introduce surgical technique and primary clinical outcomes of posterior vertebral column resection(PVCR) combined with titanium mesh bone grafting for severe thoracolumbar angular kyphosis. [Methods] From February 2004 to July 2015, 13 patients underwent PVCR combined with titanium mesh bone grafting for severe thoracolumbar angular kyphosis in our department. A posterior incision was made to expose the segments involved, and pedicle screws were individually inserted on the proximal and distal segments to the osteotomy. After posterior soft tissue release and temporary fixation with a rod were conducted, the total PVCRs on the apex were done to correct the kyphotic deformity. Based on the length of spine defect measured, a titanium mesh filled with bone autograft in proper length was implanted on the interbody gap with granular bone grafts around the mesh. Fixation of the spine was finished with bilateral pre-curved rods on the pedicle screws under proper compression. [Results] All the 13 patients had the surgical procedures performed successfully, without iatrogenic injuries to blood vessels, nerves and internal organs. The postoperative correction was of 75.89% on the sagittal plane, 87.01% on the coronal plane and 74.88% in distance of sagittal deviation. The follow-up period lasted for 25 to 106 months. To the latest followup, no correction losses in Cobb’s angles of the sagittal and coronal planes were noticed in anyone of them, whereas all patients got solid bony fusion on radiographs. [Conclusion] The PVCR combined with titanium mesh bone grafting is an effective procedure to correct severe thoracolumbar angular kyphosis, with advantages of preventing over spinal cord shortening and improving reconstruction of spinal stability.

关 键 词：重度脊柱角状后凸 全椎切除 钛网周围植骨 脊柱稳定性重建 

分 类 号：R682.3[医药卫生—骨科学]