摘要
目的探讨前后路手术治疗儿童静止期脊柱结核后凸畸形的疗效。方法2006年7月至2007年8月,手术治疗儿童静止期脊柱结核后凸畸形患者16例,男9例,女7例;年龄6～15岁,平均11岁;脊柱结核病程2～13年,平均81个月。病变部位为T_6～L_3,其中累及1个椎体2例,2个椎体3例,3个椎体7例,4个椎体2例,5个椎体2例。所有患者确诊脊柱结核后均行正规抗结核药物治疗1年以上,均无低热、盗汗等症状,血细胞沉降率、C反应蛋白均在正常范围,均未行病灶清除等手术治疗。其中4例有神经损害表现,表现为双下肢的麻木、乏力,尚可行走;其余12例表现为背部后凸畸形,尚无其他不适。手术方式为前路松解、减压、支撑植骨、内固定术及后路截骨、后凸矫形、植骨、椎弓根螺钉内固定术,通过观察患者植骨融合情况、外观变化、后凸及侧凸角度变化、神经功能变化来评价疗效。结果全部获得随访,随访时间2～3年,平均28个月。所有患者均融合良好,无一例发生假关节及内固定失败,患者外观改善明显,4例有神经损害的患者均恢复正常。术前后凸Cobb角为40°～68°,平均55.8°,术后后凸Cobb角为-4°～49°,平均21.7°,随访时后凸Cobb角为-4°～52°,平均23.2°,矫正丢失0°～5°,平均1.5°;术前侧凸Cobb角为0°～22°,平均6.9°,术后侧凸Cobb角为0°～6°,平均0.8°,随访时侧凸Cobb角为0°～8°,平均0.9°,矫正丢失0°～2°,平均0.1°。无一例发生神经并发症,1例发生伤口延迟愈合,经换药2周后愈合。结论采用前后路手术治疗儿童静止期脊柱结核后凸畸形,既可矫正后凸畸形,又可预防患儿在生长发育过程中畸形的进一步加重。
Objective To report outcomes obtained from anterior and posterior surgery for kyphosis in children in healed stages of spinal tuberculosis. Methods We retrospectively reviewed 16 patients with tuberculosis of the spine in healed stages who underwent anterior release, decompression, and instrumented fusion, followed by posterior osteotomy, deformity correction and pedicle screw instrumented fusion. The outcomes were evaluated by observing fusion, cosmetic changes, kyphosis changes, seoliosis changes, and changes of neurologic status. Results The mean follow - up was 28 months （range, 2-3years）. All the patients had bony fusion. No cases had failure of fixation. Good cosmetic results were achieved in all patients postoperatively. Nerve function recovered all 4 patients with paraplegia. The mean preoperative angle of kyphosis was 55.4° （range, 40° -68°） that reduced to 21.7° （range, -4° -49°） postoperatively. The mean angle of kyphosis at the last follow - up was 23.2° （ range, - 4° - 52°）. The mean correction loss was 1.5° （range, 0° -5°）. And the mean preoperative angle of seoliosis was 6. 9°（range, 0° -22°） that reduced to 0. 8° （range, 0°- 6°） postoperatively. The mean angle of kyphosis at the last follow - up was 0. 9° （ range, 0° - 8 °）. The mean correction loss was 0. 1 ° （range, 0° -2°）. No complication of nerve system happened. Wound delayed union was observed in one patient and treated with daily dressing and it got union two weeks after the operation. Conclusion Combined anterior and posterior surgery can both correct the kyphotic deformity effectively and halt the progress of kyphosis for children in healed stages of spinal tuberculosis.
出处
《中国骨与关节外科》
2009年第5期357-361,共5页
Chinese Journal of Bone and Joint Surgery
关键词
脊柱
结核
前后路手术
后凸畸形
Spine
Tuberculosis
Anterior and posterior surgery
Kyphosis
