COA:中重度青少年颈椎后凸畸形外科分期治疗策略

目的 探讨并总结Cobb角大于35度的中度、重度青少年颈椎后凸畸形外科分期治疗策略。方法 回顾性分析 例该类青少年颈椎后凸畸形患者。根据文献报导分为中度、重度两组：治疗前的后凸Cobb角中度组为46.6°±4.8°，共17例，重度组为61.6°±4.8°，共9例。采取分期治疗，对中度组患者先行颅骨牵引（3-5 kg）5～7天，再行颈椎前路矫形植骨内固定术；对重度组患者先行前路松解术，术后行颅骨牵引（1/10体重）7～10天，二期行颈前路矫形植骨内固定术。结果 术后3天X线片显示，Cobb角中度组为-8.9°±6.8°，重度组为-6.0°±6.3°。患者外观畸形明显矫正，颈痛及神经症状改善明显。结论 对Cobb角大于35度的青少年颈椎后凸畸形患者进行全面评估，采取外科分期治疗可以形成较为合理的治疗策略。

COA:Surgical staged treatment for moderate to severe adolescent cervical kyphosis

Background: Adolescent cervical kyphosis refers to manifestation characterized by loss of physiological cervical lordosis with involvement of multiple cervical vertebrae. There is no standard treatment strategy for this disease, especially in the patients who need surgical intervention. The aim of this study was to evaluate the surgical staged treatment for moderate to severe adolescents cervical kyphosis. Methods: A total of 28 adolescent with cervical kyphosis were retrospectively assigned into following two groups according to the magnitude of kyphosis: moderate group (n=17), the Cobb angle was 46.6 ± 4.8°. The surgical procedure was that skull traction was first carried out for 5-7 days and then the anterior fusion and instrumentation were performed. Severe group (n=9), the Cobb angle was 61.6 ± 4.8°. The treatment strategy was that the anterior release were first performed, followed by skull traction for 7-10 days, and then anterior fusion were performed. Radiographic evaluation was performed postoperatively.Results: Three days after surgery, the X-ray examination showed that the Cobb angle was -8.9 ± 6.8° in the moderate group and -6.0 ± 6.3°in the severe group. The deformed appearance was obviously corrected, with neck pain and neurologic function improved significantly. Further magnetic resonance imaging (MRI) indicated the physiology curvature of the cervical spine had been reconstructed.Conclusion: Surgical staged treatment may be an ideal therapeutic intervention for cervical kyphosis patients with a Cobb angle exceeding 35° in adolescents.