后路全脊椎截骨术治疗先天性脊柱侧后凸畸形

目的评价后路全脊椎截骨术治疗先天性脊柱侧后凸畸形的临床效果。方法 2007年8月至2009年12月,采用后路全脊椎截骨术治疗先天性脊柱侧后凸畸形病例21例,男7例,女14例;年龄7～32岁,平均16.3岁;胸段19例,腰段2例;伴发脊髓纵裂7例,脊髓空洞1例,不全瘫3例。所有病例均行后路一期全脊椎截骨、矫形植骨融合固定术。测量术前、术后及随访时站立位全脊柱正侧位X线片,记录冠状面和矢状面Cobb角、顶椎偏移;记录术中出血量、手术时间及围手术期并发症。结果所有患者切口均一期愈合,随访时间16～38个月,平均22.4个月。本组病例手术时间平均为694.5min,术中出血量平均2429ml,冠状面Cobb角由82.9°矫正到36.0°,平均矫形率56.6%,矢状Cobb角由82.5°矫正到39.8°,平均矫形率51.8%,顶椎偏移由27.1mm矫正到11.1mm,矫正率59.0%。1例术后神经诱发电位示右胫后神经SEP降低,2周后恢复,无其他神经系统并发症,椎体间植骨病例随访时均获得融合,无内固定松动、断裂等并发症。结论后路全脊椎截骨椎体切除可直接去除致畸原因,在冠状面和矢状面上均可获得良好的矫形,并可获360°减压,是目前治疗先天性脊柱侧后凸畸形较为有效的方法。

Posterior total vertebral osteotomy for the treatment of congenital kyphoscoliosis

Objective To evaluate the clinical efficacy of posterior total vertebral osteotomy for the treatment of congenital kyphoscoliosis.Methods From August 2007 to December 2009,21 patients with congenital kyphoscoliosis deformity were surgically treated with posterior total vertebral osteotomy.There were 7 males and 14 females with an average age of 16.3 years（7-32 years old）.There were 19 cases of deformity on thoracic segments and 2 cases on lumbar segments. Of them,7 cases accompanied with myeloschisis,1 case with syringomyelia,3 cases with incomplete paralysis.All those patients underwent one - stage posterior total vertebral osteotomy.The pre - operative,post - operative and follow -up X—ray of standing position was taken.The kyphotic and scoliotic Cobb angles,bleeding and surgical time were recorded. Results The incisions of all the patients achieved primary healing.The duration of follow - up lasted for 16 - 38 months with an average of 22.4 months.The average surgery time was 694.5 minutes and average blood loss volume was 2429 ml.There were no case but one with SEP decrease of the right posterior ribial nerve post - operatively but recovered 2 weeks later.The pre - operative average kyphosis and scoliosis Cobb angles were 82.5°and 82.9°.And the post - operative average kyphotic and scoliotic curve was 39.8°and 36.0°.The correction rate for kyphosis and scoliosis was 51.8% and 56.6%,respectively.There was no major complications,such as neurological injury,internal fixation loosening. Conclusion One stage posterior vertebral osteotomy is an effective and safe surgical technique for managing congenital kyphoscoliosis.