经后路全脊椎切除在重度脊柱侧凸的临床应用

目的探讨经后路全脊椎切除术在矫治〉100°的重度脊柱侧凸时的临床应用特点及技术优势。方法回顾性分析2004年10月～2008年9月以全脊椎切除术联合椎弓根钉棒治疗的13例重度侧凸患者,术前主弯Cobb角平均117.8°,冠状面偏斜平均6.7cm;术中置入直径为5.5～6.5mm椎弓根螺钉,通过全脊椎切除建立矫形空间后,直视下保护硬膜囊,获得脊柱冠状面整体平衡和侧凸矫形。结果平均侧凸矫形率为60.7%,冠状面偏斜纠正82.0%。术后1例发生脊髓缺血再灌注损伤,2周后恢复,其余患者神经功能Frankel分级同术前。术后6个月时,患者肺功能均较术前有所改善。平均随访22.5个月,矫形效果丢失〈10%,1例内固定棒断裂。结论经后路全脊椎切除联合椎弓根钉棒器械矫形术可有效保护脊髓功能,获得良好矫形效果,适用于重度脊柱侧凸患者,特别是对伴有显著通气功能障碍的胸段侧凸。

Clinical application of posterior vertebral column resection in severe scoliosis

Objective To evaluate the clinical application features and explore the technique predominance of posterior vertebral column resection in correcting severe scoliosis with major curve over 100°. Methods Thirteen cases of scoliosis with major curve over 100°which underwent posterior vertebral column resection combined with pedicle instrumentation treatment from October 2004 to September 2008 were reviewed. Preoperative mean Cobb's angle was 117.8°and divergence distance of spine on coronal plate was 6.7 cm. Screws with diameter from 5.5 mm to 6.5 mm were chosen and inserted in, and then vertebral column resection was performed in order to build the correction gap though which the dura can be protected by insight and deformity correction with trunk balance be accomplished. Results The average scoliosis correction rate was 60.7%, and trunk deviation was 82.0%. Spinal cord ischemical reperfusion injury occurred postoperatively in 1 case and recovered the average correction rate of 2 weeks later. For the rest, there were no iatrogenic neurological deficits observed. All the patients' pulmonary function at 6 months postoperative was improved. The mean follow-up duration was 22.5 months. The Cobb's angle of scoliosis after correction of deformity was lost less than 10%. Internal fixator rod breakage occurred in 1 case. Conclusion Posterior vertebral column resection combined with pedicle instrumentation is effective in correcting severe scoliosis and safety to protect spinal cord function, especially to those with moderate or severe restrictive ventilatory defect.