摘要
目的 探讨单纯后路脊椎切除治疗僵硬型角状脊柱后凸畸形的临床疗效.方法 2001年5月至2007年12月,对41例僵硬型角状脊柱后凸患者行单纯后路脊椎切除术前脊柱后凸Cobbb角平均43.8°,26例同时伴有脊柱侧凸畸形,侧凸Cobb角平均39.1°.7例有不同程度的神经受损症状,Frankel分级C级2例,D级5例.通过术前、术后脊柱正、侧位X线片,神经功能Frankel分级,评价矫形效果、神经功能,观察手术并发症,分析临床疗效.结果 41例患者均获随访,随访时间1年4个月～7年3个月,平均3年11个月,术中出现2例椎弓根骨折,3例椎弓根螺钉拔出现象,术后出现1例气胸,2例局部感染,6例神经系统并发症.术后2周后凸C0bb角平均9.8°,矫正率77.6%,术后2周侧凸Cobb角平均10.°,矫正率为74.4%,畸形角度与躯干平衡情况较术前获得明显改善,与术前相比差异有统计学意义(P<0.001).术后6个月复查,所有病例固定融合节段均获骨性融合,所有病例矫形效果均无明显丢失,与术后2周比较差异无统计学意义(P>0.05).7例具有神经症状患者中,4例好转,2例无变化,1例加重;Frankel分级E级3例,D级3例,B级1例.结论 采用单纯后路脊椎切除治疗僵硬型角状脊柱后凸畸形能直接去除致病因素,可获得良好的矫形效果,临床疗效满意.
Objective To evaluate the effect of single-stage posterior vertebral column resection for rigid angular kyphosis.Methods From May 2001 to December 2007,a consecutive series of 41 patients with rigid angular kyphosis were treated by posterior vertebral column resection.The mean preoperative Cobb angle of kyphosis was 43.8°,and the Cobb angle of scoliosis was 39.1°.The coronal and the sagittal angles were analyzed to determine the corrective effect of kyphosis and scoliosis on standing anterior-posterior and lateral plain films.Trunk balance and Frankel grade were also measured before and after operation.Results The average time of follow-up was 47 months (range,from 16 months to 87 months).Intraoperative,two patients had pedicle fracture,three cases underwent pedicle screw pull out.There was a mean improvement of 77.6% for kyphosis from a mean angle of 43.8° before surgery to 9.8° two weeks after surgery.The correcton ratio for scoliosis was 74.4%,improved from 39.1° to 10.0°.Deformity angle and the trunk balance were significantly improved postoperatively.Postoperative complication included: pneumothorax in 1 patient;local infection in 2 patients and neurological dysfunction in 6 patients.Postoperative neurologic improvement was observed in four patients,No obvious relief was found in 2 patients.Only one patient.whose Frankel grade had changed from C to B had worsen.There were grade E in 3 patients, grade D in 3 patients and grade B in 1 patient. All patients got bony fusion within 6 months.There was no obviously correction loss at the final follow up (P>0.05).Conclusion Single-stage posterior vertebral column resection a reliable and safe surgical technique for correcting rigid angular kyphosis.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2009年第12期1099-1103,共5页
Chinese Journal of Orthopaedics
基金
湖南省卫生厅科研项目（项目编号:B2006-040）
湖南省科技厅科技计划一般项目（项目编号:06SK3015）
