【摘要】 目的总结经后路顶椎区楔形截骨矫形内固定治疗僵硬性脊柱侧弯的手术方法 ,探讨其融合固定范围及手术适应证的选择。方法 1999年7月-2009年1月,对23例僵硬性脊柱侧弯采用后路顶椎区楔形截骨矫形内固定术。男11例,女12例;年龄8～29岁,中位年龄15岁。先天性脊柱侧弯16例,特发性脊柱侧弯5例,神经纤维瘤病2例。既往有脊柱矫正手术史2例。脊柱侧凸主弯Cobb角(85.39±13.51)°;后凸Cobb角(56.78±17.69)°;躯干偏移(15.61±4.89)mm。CT或MRI检查显示2例合并骨性纵裂畸形。结果手术时间平均241min,术中出血平均1452mL。术中固定融合节段8～14个椎体,平均10.7个。术后23例均获随访,随访时间1～4年,平均2年6个月。术后即刻脊柱侧凸主弯Cobb角为(38.70±6.51)°,后凸Cobb角为(27.78±6.01)°,躯干偏移(4.69±1.87)mm,身高增加平均5.2cm。末次随访时脊柱侧凸主弯Cobb角为(41.57±6.80)°,后凸Cobb角为(30.39±5.94)°,躯干偏移(4.78±2.00)mm。术前主弯Cobb角、后凸Cobb角和躯干偏移与术后即刻及末次随访比较,差异均有统计学意义(P<0.05);术后即刻与末次随访比较,差异无统计学意义(P>0.05)。手术并发症包括术中椎弓根骨折4例,L1神经根损伤1例,肠系膜上动脉综合征2例,术后切口渗液1例,切口积液2例,一过性双侧下肢神经功能障碍2例,经对症处理后均治愈。结论采用后路顶椎区楔形截骨矫形内固定术治疗僵硬性脊柱侧弯是一种安全、可靠的方法 ,通过椎弓根螺钉的应用,可以达到良好的矫形效果。更多还原

【Abstract】 Objective To introduce operation skill of the spinal wedge osteotomy by posterior approach for correction of severe rigid scoliosis and to discuss the selection of the indications and the range of fusion and fixation.Methods Between July 1999 and January 2009,23 patients with severe rigid scoliosis were treated with spinal wedge osteotomy by posterior approach,including 16 congenital scoliosis,5 idiopathic scoliosis,and 2 neurofibromatosis scoliosis.There were 11 males and 12 females with a median age of 15 years(range,8-29 years).Two patients had previous surgery history.The Cobb’s angles of scoliosis and kyphosis before operation were(85.39 ± 13.51)° and(56.78 ± 17.69)°,respectively.The mean spinal flexibility was 14.4%(range,4.7%-22.5%).The trunk shift was(15.61 ± 4.89) mm.The preoperative CT or MRI showed bony septum in the canal in 2 patients.Results The mean operative time was 241 minutes and the mean blood loss was 1 452 mL.The average fused vertebrae were 10.7 segaments(range,8-14 segaments).The follow-up ranged from 1 to 4 years with an average of 2 years and 6 months.The postoperative Cobb’s angle of scoliosis was(38.70 ± 6.51)°,the average correction rate was 54.7%.The postoperative Cobb’s angle of kyphosis was(27.78 ± 6.01)°,the average correction rate was 51.0%.The trunk shift was improved to(4.69 ± 1.87) mm,the increased height was 5.2 cm on average(range,2.8-7.7 cm).The Cobb’s angle of scoliosis was(41.57 ± 6.80)° with an average 2.9° loss of correction at the final follow-up;the Cobb’s angle of kyphosis was(30.39 ± 5.94)° with an average 2.6° loss of correction at the final follow-up;the trunk shift was(4.78 ± 2.00) mm at the final follow-up.There were significant differences(P < 0.05) in the Cobb’s angles of scoliosis and kyphosis and the trunk shift between preoperation and postoperation,between preoperation and last follow-up.Four cases had pedicle fracture,1 had L1 nerve root injury,2 had superior mesenteric artery syndrome,1 had exudates ofincision,and 2 had temporary dysfunction of both lower extremity.Conclusion Spinal wedge osteotomy by posterior approach is a reliable and safe surgical technique for correcting severe rigid scoliosis.With segmental pedical screw fixation,both the spinal balance and stability can be restored.更多还原