【摘要】 [目的]介绍一期后路楔形截骨治疗青春期后严重的先天性脊柱畸形的安全操作及探讨其融合固定范围的选择。[方法]自2000年2月~2006年7月对16例青春期后严重的先天性脊柱侧弯采用一期后路楔形截骨内固定矫形。男10例,女6例;年龄16~29岁,平均21.4岁。其中单纯半椎体11例,半椎体合并对侧骨桥或肋骨融合5例,既往有脊柱矫正手术史者2例。术前脊柱侧凸Cobb’s角64°~108°,平均84.7°;脊柱后凸角28°~91°,平均52.6°;躯干偏移3~23.6 mm,平均15.4 mm。CT或MRI显示椎管内骨性分隔2例。[结果]手术时间平均231 min,术中出血平均1 400 ml。术后平均随访2年6个月。固定融合节段8~14个椎体,平均10.6个。侧凸Cobb’s角18°~47°,平均38.5°,平均矫正率54.5%;后凸Cobb’s角15°~40°,平均27.7°,平均矫正率47.4%;术后躯干偏移0~11.4mm,平均为4.6 mm。侧、后凸和躯干偏移无明显矫正丢失。手术并发症包括术中椎弓根骨折2例;L1神经根损伤1例;肠系膜上动脉综合征1例;术后切口渗液1例。[结论]采用一期后路楔形截骨内固定治疗青春期后严重的先天性脊柱侧弯是一个安全、可靠的方法,矫形效果满意,远期疗效可靠。更多还原

【Abstract】 [Objective]To introduce the safety of the spinal wedge osteotomy by a single posterior approach and to discuss the selection of fusion and fixation. [Method]Sixteen patients with severe post-adolescent congenital spinal deformities were treated by spinal wedge osteotomy by a single posterior approach from February 2000 and July 2006.There were 10 males and 6 females with an average age of 21.4 years(range 16 to 29 years).There were 11 patients with hemivertebre and 5 with fused ribs or bone bridge.Two patients had previous surgery history.The average Cobb’s angles of scoliosis and kyphosis before operation were 84.7 °and 52.6°.The average trunk shift was 15.4 mm.Bony septum in the canal was found in 2 patients on the preoperative CT or MRI.[Result]The follow-up ranged from 2 to 4 years with an average of 2 years and six months.The average fused vertebrae were 10.6 segments(range 8 to 14 segments).The postoperative average Cobb’s angles of scoliosis and kyphosis were 38.5 and 27.7.The average correction rates of scoliosis and kyphosis were 54.5% and 47.4%.The average trunk shift was improved to 4.6 mm.There was no significant correction loss of the scoliosis,kyphosis and trunk shift at final follow-up evaluation.No patient developed severe complications except that two had pedicle fracture,one had L1 nerve root injury,one had superior mesenteric artery syndrome and one had exudates of incision.[Conclusion]Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe post-adolescent congenital spinal deformities.更多还原