后路凹侧松解联合双极楔形截骨治疗分节不全型重度脊柱侧凸

目的:探讨后路凹侧松解联合双极楔形截骨治疗分节不全型重度脊柱侧凸的临床效果及其安全性。方法:自2004年11月～2009年10月,采用经后路凹侧肋椎关节松解和对分节不全脊柱节段行双极楔形截骨治疗重度脊柱侧凸患者14例。其中男8例,女6例,年龄14～22岁,平均17.6岁;术前冠状位侧凸Cobb角83°～139°,平均99.4°;侧凸柔韧性7.8%～20.1%,平均14.3%;冠状位偏移距离0.8～6.3cm,平均3.4cm。3例合并有胸椎后凸畸形,2例合并胸椎前凸畸形。收集手术时间、出血量、并发症、术后及未次随访时的侧凸Cobb角和冠状位偏移距离等临床数据并分析。结果:手术时间6.4～11.2h,平均8.6h;术中出血量3100～4500ml,平均3750ml。凹侧肋椎关节松解4～6个,平均5.2个。1例因椎弓根钉侵入T5椎管致左下肢不全性瘫痪,后经拔除该钉,3个月后脊髓神经功能完全恢复。1例术中发生血气胸,术后行胸腔闭式引流,2周后痊愈。术后随访24～48个月,平均32.6个月。末次随访时侧凸Cobb角12°～53°,平均34.9°,矫正率50.5%～87.2%,平均65.3%;冠状位偏移距离为0.4～2.6cm,平均1.0cm,矫正率12.5%～89.5%,平均65.9%。末次随访时所有患者获得良好的骨性愈合,内固定无断钉及松动,矫正度无显著丢失。结论:后路凹侧肋椎关节松解联合双极楔形截骨治疗椎体分节不全型重度脊柱侧凸,能较好地改善脊柱的柔韧性并保持截骨间隙的相对稳定,是治疗椎体分节不全型重度先天性脊柱侧凸安全有效的方法。

Posterior concave side release plus double wedge-osteotomy at both ends for severe congenital scoliosis

Objectives: To investigate the clinical outcome and reliability of posterior concave side release plus double wedge-osteotomy at both ends for severe congenital scoliosis.Methods: From November 2004 to October 2009,14 patients suffering from severe congenital scoliosis underwent posterior costotransversectomy release at concave side and double wedge-osteotomy at both ends.There were 8 males and 6 females with an average age of 17.6 years(range,14-22 years old).The average pre-operative Cobb angle of scoliosis was 99.4°(range,83°-139°);the average spinal flexibility of scoliosis was 14.3%(range,7.8%-20.1%).The average vertical distance between C7 and center of sacral line was 3.4cm(range,0.8-6.3cm).The clinical data including operation time,blood loss,complications,rate of correction immediately after operation and at last follow-up were reviewed retrospectively.Results: The average operation time was 8.6 hours with an average blood loss of 3750ml(3100-4500ml).The average number of costocentral joint released was 5.2(4-6).One case presented with paralysis at left lower limb due to the T5 spinal canal penetration by pedicle screw,and the screw was removed.The neurofunction of the left limb recovered completely three months later.1 patient developed hemopneumothorax during operation,which was resolved completely after chest cavity close drainage for 2 weeks.All patients were followed up for an average of 32.6 months(range,24-48 months).At final follow-up,the average Cobb angle was 34.9°(range,12°-53°),with a correction rate of 65.3%.The average post-operative vertical distance between C7 and center of sacral line was 1.0(range,0.4-2.6cm),with an average correction of 65.9%(12.5%-89.5%).Bony fusion was achieved in all patients,and no instrument failure or significant loss of correction was noted.Conclusions: Concave side costotransversectony release and wedge-osteotomy at both ends can improve the spinal flexibility and stability,which is a safe and effective alternative to achieve correction.