摘要
目的:评价一期后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形的疗效。方法:采用自制的"V"型截骨刀一期后路经椎弓根半椎体切除内固定矫形治疗52例完全分节型胸腰椎半椎体畸形所致的脊柱侧后凸畸形患者。应用术前、术后X线片冠状面节段侧凸角、总侧凸角和代偿侧凸角以及矢状面节段后凸角或前凸角、躯干侧移程度对治疗结果进行评估。结果:手术时间120～310min,术中失血量300～600ml。固定融合椎体节段数2～4个。所有病例随访2年7个月～5年,平均3年5个月。1例术中凸侧节段加压时头端椎弓根被螺钉割裂,向上延长一个椎体固定;2例术后出现神经根性分布的一侧肢体麻木、胀痛,3个月随访时症状消失;3例患者因术中行胸神经根切断,术后出现支配区域束带感,术后2个月缓解。1例因内固定钉帽切迹导致皮肤溃烂,1年后复查已骨性融合,取出内固定后治愈。1例5个月复查时出现椎弓根被螺钉割裂,延长支具固定6个月,骨性融合后取出内固定。末次随访时节段侧凸角由术前38.5°±6.9°矫正至7.5°±3.0°,总侧凸角由术前41.2°±8.1°矫正至9.6°±5.1°,头侧代偿凸由术前17.5°±5.2°矫正至6.2°±4.1°,尾侧代偿凸由术前17.9°±4.9°矫正至6.1°±3.1°,后凸角由术前29.1°±12.1°矫正至6.2°±4.1°,躯干偏移由术前平均4.5cm矫正至0.4cm。各指标末次随访时与术前比较P<0.01。结论:一期后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形效果良好。
Objective：To review the clinical result of one stage excision of hemivertebrae via pedicle and short segment fusion for congenital thoracic-lumbar kyphoscoliosis complicated with fully segment hemivertebrae.Method：A consective of 52 cases with congenital thoracic-lumbar kyphoscoliosis complicated with fully segment hemivertebrae experienced one stage excision of hemivertebrae via pedicle and short segment fusion using self-made V- shape osteotome.The segment scoliotic curve angle,total scoliotic curve angle and compensatoly curve angle under corronal plane and sagittal plane as well as translational variation of trunk in terms of preoperatrive,postoperative and follow-up period were reviewed respectively.Result：Opoeration time ranged from 120 to 610 minutes and blood loss volume ranged from 300 to 600ml and avarage fused verte-braes bodies ranged from 2 to 4.All patients were followed for an average of 41 months （range,31 to 60 months）.Intraoperative vertebral excision by pedicle screw was evidenced in 1 case,which was resolved by fusion extension of 1 vertebral cranially.Neurodeficit was noted in 2 cases,which desolved in 3 months.Trunk girdle numbness was noted in 2 cases due to dissection of thoracic nerve,which dissolved in 2 months.Skin ulcer was noted in 1 case due to thread of screw cap,which dissolved by removal of instrument.Pedicle broken was noted in 1 case due to load bearing of pedicle screw.Segment seoliosis angle was corrected from preoperative of 38.5°±6.9° to the final follow-up of 7.5°±3.0°（P〈0.01）,total scoliosis angle was corrected from preoperative of 41.2°±8.1° to final follow-up of 9.6°±5.1°（P〈0.01）.The proximal compensatory curve angle was eorreeted from preoperative of 17.5°±5.2° to final follow-up of 6.2°±4.1°（P〈0.01）,distal compensatory curve angle was eorreeted from preoperative of 17.9°±4.9° to final follow-up of 6.1°±3.1°（P〈0.01）,kyphosis angle was eorreeted from preoperative of 29.1°±12.1° to final follow-up of 6.2°±4.1°（P〈0.01）,the trunk translational variation was eorreeted from preoperative of 4.5cm to final follow-up of 0.4cm（P〈0.01 ）.Conclusion：The result of one stage through pediele to eut hemivertebrae and internal fixation and fusion to treat eompletely segmental thoraeie-lumbor latero-kyphosis deformity is good.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第3期188-192,共5页
Chinese Journal of Spine and Spinal Cord
基金
陕西省科技厅社会发展资助项目(No.2003K10-G26)
