单纯后路多个全脊椎切除矫治严重脊柱侧、后凸畸形

目的评价严重脊柱侧、后凸畸形单纯后路多节段全脊椎切除,侧后凸畸形矫正技术的手术矫治效果和临床风险性。方法2003年1月~2001年1月,本院骨科收治38例严重脊柱侧、后凸畸形患者,全部病例均采用单纯后路多节段全脊椎切除的方法。全部病例手术前均行站立位X线脊柱全长片、核磁共振和三维CT重建等辅助检查,计算手术时间、出血量,观察手术前后侧后凸的矫正率、术中脊柱短缩,手术后整体平衡情况。结果本组患者均进行1.5~3个椎体的全脊椎切除,术中测量脊柱短缩42 mm(31~62 mm),手术平均用时348 m in(280~510 m in),手术中平均出血量2010 m l(1400~3200 m l)。全部病例经过1~2.5年的随访,侧凸畸形cobb角平均矫正率为56.3%(51.2%~64.2%);后凸畸形平均矫正率为75.6%(67.8%~81.4%)。所有患者躯干平衡良好,未发现失代偿现象。手术并发症包括3例出现一过性的脊髓损伤症状(1例一过性双侧下肢不全瘫、2例一过性单侧下肢不全瘫)和6例神经根性疼痛,未经特殊处理恢复正常,4例肠系膜上动脉综合症,经胃肠减压处理症愈。结论对于严重成人脊柱侧、后凸畸形患者,单纯后路顶椎附近多个椎体全脊椎切除技术三维矫正效果满意,安全有效。

Single posterior approach with multi-level vertebra column resection in severe kyphosis and scoliosis

Objective To evaluate the corrective efficacy and clinical risk of single posterior approach with multi-level vertebra column resection(VCR) in severe kyphosis and scoliosis.Methods From 2003 Jan to 2006 Jan,38 patients of severe rigid kyphosis and scoliosis treated by single posterior approach with multi-level VCR were reviewed.Long cassettes X-ray and 3D CT scan and MRI images were applied for preoperative evaluation.Operating time,blood loss and spine shorten during operation were recorded.Cobb angle of pre-or postoperation,trunk balance were also measured.Results Mean 1.5 to 3 vertebra were resected and 42mm was shortened(ranged 31-62mm) during operation in this group.Mean operating time was 348 minutes(ranged 280-510 min) with average blood loss of 2010 ml(range 1400-3200ml).All patients were followed up 1 to 2.5 years.Deformity correction was 56.3%(51.2%-64.2%) in the coronal plane and 75.6(67.8%-81.4%) in the sagittal plane.All patients got good trunk balance with no decompensation.Neurologic complication included 3 transient spinal cord injury symptoms and 6 radicular pain.They recovered with no special treatment in follow-up.Superior mesenteric artery syndrome were observed in 4 patients.They were healed with gastrointestinal decompression.Conclusion Posterior multi-levels VCR is an effective alternative for severe rigid kyphoscoliosis patients.