广泛后路松解加顶椎全椎体切除治疗重度僵硬脊柱侧后凸畸形

目的回顾分析重度僵硬脊柱侧后凸后路全脊椎切除术的临床疗效，探讨其手术并发症的防治。方法1996年6月至2007年7月，治疗重度僵硬性脊柱侧后凸畸形67例，男29例，女38例；年龄16～52岁，平均21．5岁；特发性27例，先天性21例，神经纤维瘤病9例，脊髓空洞7例，成骨不全3例。术前主弯冠状面Cobb角为81°～142°，平均97．8°；Bending位脊柱柔韧性10．5％；主弯顶椎偏距为3．7～16cm，平均8．8cm；后凸角为43°～102°，平均68．5°；矢状面C7-S1间距为-4．5～18Cm，平均5．7cm。采用主弯区顶椎全脊椎切除，椎弓根钉内固定三维矫形和360°植骨融合进行治疗。对手术时间、术中出血量、并发症、畸形矫正和随访结果进行评估。结果后路手术时间平均为420min，术中平均出血量为5100ml。所有患者均获得随访，随访时间5—54个月，平均30．5个月。术后冠状面Cobb角平均为41．3°，矫正率平均为57．8％；术后主弯顶椎偏距为1．2～5．9cm，平均2．7cm；术后后凸角平均为36．6°，矫正率平均为46．6％；术后矢状面C7-S1间距为-2．4～4．6em，平均1．5cm。术后发生短暂性下肢无力2例，永久性截瘫1例，脑脊液漏2例，乳糜漏1例，伤口感染2例，胸膜撕裂合并包裹性胸腔积液3例，假关节形成2例。术后1年以上随访主弯冠状面矫正平均丢失5．9％，后凸矫正平均丢失3．8％。结论全脊椎切除结合椎弓根内固定三维矫形治疗重度僵硬性脊柱侧凸，能有效矫正畸形和恢复脊柱冠、矢状面平衡，但应高度重视大出血和神经系统损伤并发症。

Complications and clinical results Of vertebral column resection for the treatment of severe rigid kyphoscoliosis

Objective To evaluate the surgical results and safety of vertebral column resection for severe rigid kypho-scoliosis and to discuss the preventation of complications. Methods Totally 67 patients of severe kyphoscoliosis were treated from June 1996 to July 2007. There were 29 males and 38 females with an average age of 21.5 years old. Type including idiopathic in 27 patients, congenital in 21, neurofibromatosis in 9, syringomyelia in 7 and osteogenesisimperfecta in 3. The average preoperative Cobb＇s angle of main curve in the coronal plane was 97.8° （81 °～ 142°）, the automatical correct rate 10. 5% on the bending film. The apical vertebral translation was 8.8 （3.7 - 16） cm before operation. The kyphotic angle was 68.5° （43° - 102° ） in average, the distance of sagital plane between C7 plumb line and the posterior superior comer of S1 was 5.7 （ -4. 5 - 18） cm before operation. Surgical methods： vertebral column resection of apex vertebrae in the region of main curve, instrumentation by the pedicle system and bone fusion in 360 degree. The clinical data included operative time, bleeding volume, complications, correction rate and results of follow - up. Results All cases received follow - up from 5 to 54 months with an averaging 30. 5 months. The average postoperative Cobb＇s angle of main curve in the coronal plane was 41.3 ° , the correction rate was 57.8% on average, the apical vertebral translation was 2. 7 （1.2-5. 9） cm after operation. The postoperative kyphotic angle was 36.6° in average, the correction rate was 46. 6% on average, the distance of sagital plane between the vertical line of C7 and the posterior comer of S1 was 1.5 （ - 2. 4～ 4. 6 ） cm after operation. The average anterior operative time was 420 min, the bleeding volume with a mean of 5100 ml. Complications including transient lower extremity weakness in 2 cases, pemanence paraplegia in 1 case, leakage of cerebrospinal fluid in 2 cases, leakage of chylus in 1 case, wound infection in 2 cases, wrapped pleura