钛网置入与全脊椎切除在重建严重脊柱畸形椎体中的应用

背景：不论是传统的单纯前路凹侧支撑、前路松解联合后路矫形,还是近年来较多学者提倡的经后路脊柱闭合楔形截骨等方法,均不能有效治疗临床严重僵硬脊柱侧后凸畸形。目的：总结经后路全脊椎切除应用于严重角状侧凸或/和后凸畸形的临床经验,观察该方案以及钛网置入对患者脊髓功能的影响。方法：回顾性分析2004-10/2008-12采用全脊椎切除治疗的脊柱畸形病例中,畸形呈角状的侧凸或/和后凸,主弯角度在冠状面或/和矢状面上测量〉100o,且畸形的柔韧度小于10%的15例患者。脊髓功能2例Frankel评分为D,余均为E级。采用肋骨横突切除入路显露,结扎顶椎区节段血管,置入椎弓根钉,完成全脊椎切除后采用交替换棒技术,并置入钛网,以此获得矫形。治疗过程中未使用感觉或运动诱发电位监测。治疗后随访普通X射线片Cobb角矫正与神经功能变化。结果与结论：平均术中切断（3.8±1.4）支节段血管。治疗后测量侧凸及后凸畸形矫形率分别为60.8%和72.9%。随访6～48个月,至随访终末所有病例Frankel评分E级,部分患者治疗前存在的肌张力增高及肛门括约肌松弛等均恢复正常,内固定物无脱落、松动等。提示严重且僵硬的角状脊柱畸形患者,采用经后路全脊椎切除加椎弓根钉棒系统内固定可获得良好矫形效果。在稳定的力学环境和直视保护下,脊髓可耐受一定范围的短缩、成角和旋转位移。通过对脊髓的环周减压,保持脊髓等张或短缩状态的矫形,利于病态脊髓的功能恢复。

Posterior vertebral column resection and titanium mesh implantation for the treatment of severe spinal angular deformity

BACKGROUND：No matter anterior strut-grafting,anterior release combined with posterior correction or posterior wedge osteotomy,can not treat severe spinal angular deformity effectively.OBJECTIVE：To summarize the clinical experience of the posterior vertebral column resection （PVCR） in the treatment of angular scoliosis and kyphosis,and to discuss the influence about spinal cord.METHODS：From 2004 October to 2008 December,15 patients with severe rigid angular kyphosis and scoliosis treated by PVCR were retrospective analyzed.The major curve of all cases in the coronal or/and sagittal plane100°,and flexibility less than 10%.There were 2 patients with spinal cord injury and Frankel grade D.Other cases was E.A thorough rib and transverse process resection of the exposed posterior vertebral column was performed.The top segments vessel was ligated and completely resection with the apex to correction.The temporary rods were exchanged alternately.In the process,somatosensory-evoked potentials and eurogenic mixed-evoked potentials （NMEPs） were not used.The Cobb angle correction and neural function changes were compared.RESULTS AND CONCLUSION：Average （3.8±1.4） segment vessels were cut in the operation.Deformity correction was 60.8% in the coronal plane and72.9% in the sagital plane.Patients were follow-up for 6-48 months,and all patients Frankel grade was E.Part of patients had muscle tension and anal sphincter muscle relaxation recovered to normal.No grafting shedding or loosening occurred.PVCR is an effective alternative and can obtain good correction for severe rigid angular kyphoscoliosis patients.In the stable mechanical and look,spinal cord can tolerate appropriate short,angles and displacement.Through circumferential decompression,and keep spinal cord isotonic and appropriate short,spinal cord function will recover.