后路椎体环截及钛合金钉棒内固定治疗重度脊柱畸形

背景：椎体环截是近年来提出较多的脊柱矫形概念,因其操作技巧要求高,难度大,并发症多,既往相关文献报道角度各不相同,很多研究者注重并发症分析,究其原因与操作步骤及方式有关。 目的：分析单纯后路椎体环截及螺钉置入治疗重度脊柱畸形的疗效和并发症。 方法：回顾性分析48例单纯后路椎体环截及螺钉置入治疗重度脊柱畸形患者的临床资料,平均切除椎体1.6个,随访15-64个月,分析所有患者治疗前、治疗后及最后一次随访时Cobb角(冠状面及矢状面),并对手术相关并发症进行分析。 结果与结论：纳入的脊柱畸形患者共分5类,其中脊柱侧后凸畸形11例,重度侧凸畸形20例,先天性脊柱畸形4例,球状后凸畸形3例,角状后凸畸形10例。所有患者治疗前平均冠状面畸形角度由84°矫正到35°,总的矫正率达到54%。治疗前平均矢状面畸形角度由90°矫正到42°,矢状面 Cobb 平均减小了48°。手术时间平均545 min(204-1 355 min),术中平均估计失血量 1 610 mL(50-8 244 mL),平均失血量达65%。31例治疗后出现并发症,其中13例术中神经功能异常(通过电生理监测及唤醒实验发现),及时处理后患者未出现永久性神经功能障碍。提示单纯后路椎体环截及螺钉置入治疗重度脊柱畸形效果良好,但并发症高,操作难度较大。

Posterior vertebral column resections combined with titanium screw rod fixation for the treatment of severe spinal deformity

BACKGROUND: Vertebral column resection is the frequently mentioned spinal orthopaedic concept. Due to the high requirement of the operation skill, difficulty and more complications, the previous studies have reported from different aspects, and many researchers have focused on the analysis of complications, that may be related with the procedure and manner.    OBJECTIVE: To analyze the efficacy and complications of posterior vertebral column resection combined with titanium screw rod fixation for the treatment of severe spinal deformity. METHODS:We retrospectively analyzed 48 patients with severe spinal deformity who treated with posterior vertebral column resection and titanium screw rod fixation, with an average removal of 1.6 vertebral. The patients were followed-up for 15-64 months. The Cobb angle (coronal plane and sagittal plane) of the patients before treatment, after treatment and in the final follow-up was analyzed, and the relative complications of the surgery were analyzed.  RESULTS AND CONCLUSION: The patients with spinal deformity were divided into five categories, included kyphoscoliosis (n=11), severe scoliosis (n=20), congenital spinal deformity (n=4), spherical kyphosis (n=3), and angular kyphosis (n=10). The average coronal plane deformity angle of the patients was corrected from 84° preoperation to 35° postoperation, with the total correction rate of 54%. The average sagittal plane deformity angle was corrected from 90° preoperation to 42° postoperation, and the sagittal plane Cobb angle was decreased for 48°. The mean operation time was 545 minutes (204–1 355 minutes), the intraoperative blood loss was 1 610 mL (50–8 244 mL), and the average blood loss was 65%. After treatment, 31 cases had complications, including 13 cases of intraoperative neurological dysfunction (observed through electrophysiological monitoring and wake), permanent neurological dysfunction did not occur after timely treatment. The posterior vertebral column resection and titanium screw rod fixation can obtain better effect in the treatment of severe spinal deformity, but the procedure has high complications and is difficult for operation.