摘要
目的探讨一期后路截骨矫形治疗儿童静止期脊柱结核性后凸（侧后凸）畸形的疗效。方法2002年1月至2012年12月手术治疗儿童静止期脊柱结核性后凸（侧后凸）畸形18例，男6例，女12例；年龄4～15岁，平均8．2岁；脊柱结核病程10个月～120个月，平均37．1个月。脊柱后凸畸形位于颈胸交界区2例、胸椎10例、胸腰段5例、腰椎1例。病变累及2个椎体3例、3～5个椎体9例、5个椎体以上6例。其中6例合并脊髓神经损害，Frankd分级C级2例、D级4例。均采后路截骨矫形植骨融合内固定术，经椎弓根截骨16例，全椎体切除截骨2例。术前、术后及随访时摄站立位全脊柱X线片，测量矢状面主弯后凸Cobb角、冠状面主弯侧凸Cobb角及躯干矢状偏移距离，记录脊柱融合固定节段和融合情况。结果18例均获得随访，随访时间11～97个月，平均27．8个月。固定节段为5～17个椎体，平均9．6个；融合节段为2～8个椎体，平均4．4个。矢状面后凸由术前平均71．6°矫正至14．5°，矫正率79．7％；冠状面侧凸Cobb角由术前平均9．4°矫正至0．7°。躯干矢状偏移距离由术前平均3．7mm矫正至术后0．5mm，平均矫正3．2mm。末次随访时神经功能均获改善。围手术期主要并发症包括内固定松动4例，胃肠功能障碍2例，胸膜破损5例，脑脊液漏3例。结论对儿童静止期脊柱结核件后凸（侧后凸）畸形采用后路截骨矫形及内固定是较为安全、有效的方法，融合范围选择和截骨矫形技术是成功的关键。
Objective To evaluate the efficacy and safety of one-stage posterior wedge osteotomy for correction of kypho- sis or kyphoscoliosis in children with healed stages of spinal tuberculosis. Methods From January 2002 to December 2012, we retrospectively reviewed 18 patients with tuberculosis of the spine in healed stages which underwent one-stage posterior wedge os- teotomy. There were 6 males and 12 females, whose average age was 8.2 （4 to 15） years and average followed-up time was 37.1 （10 to 120） months. The apical vertebrae were located at cervieothoracic segment in 2 cases, thoracic segment in 10 cases, thoracolum- bar segment in 5 cases and lumbar segment in 1 ease. The lesions involved 2 segments in 3 cases, 3 to 5 segments in 9 cases and more than 5 segments in 6 eases. There were 6 cases with neurological dysfunction whose Frankel＇ s classification was C in 2 cases and D in 4 eases. The coronal and sagittal Cobb angels, thoracic kyphosis, lumbar lordosis, sagittal trunk shifts, number of fixation and fusion segments and bony union were measured on the standing AP and lateral radiographs before, after surgery and at the fi- nal follow-up. Results The Cobb＇ s angels in the sagittal plane were corrected from 71.6° to 14.5°, representing 79.7% correction rate. The Cobb＇ s angels in the coronal plane were corrected from 9.4° to 0.7°. Sagittal trunk shift was obviously improved from 3.7mm to 0.5mm. The average fixation segment was 9.6 （5 to 17） segments while the average fusion segment was 4.4 （2 to 8） seg- ments. The neurological function had all been improved at final follow-up. Perioperative complications consisted of fixation loosen- ing in 4 eases, gastrointestinal dysfunction in 2 cases, pleura injury in 5 cases, and eerebrospinal fluid leakage in 3 cases. Conclu- sion One-stage posterior wedge osteotomy is a safe and effective surgical technique for correction of kyphosis or kyphoseoliosis in children with healed stages of spinal tuberculosis. Both the selection of fusion levels and the appropriate technique of osteotomy are crucial to good outcomes.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2014年第2期183-188,共6页
Chinese Journal of Orthopaedics
关键词
结核
脊柱
脊柱后凸
截骨术
儿童
Tuberculosis, Spinal
Kyphosis
Osteotomy
Child
