摘要
目的:探讨后路经椎弓根扩大“蛋壳”技术行畸形脊椎切除矫治重度成人先天性脊柱侧后凸畸形患者的早期临床效果。方法:2003年5月～2005年5月,我院骨科收治重度成人先天性脊柱侧后凸患者16例,男6例,女10例;平均年龄31.8岁(21.5～44.2岁)。侧凸Cobb角70°～125°,平均85°,后凸Cobb角72°～110°,平均88°。均采用单纯后路扩大“蛋壳”技术切除侧后凸顶椎(包括顶椎邻近的头尾侧楔变的脊椎),截骨节段上下方各应用2～3对椎弓根螺钉固定,通过器械加压矫形关闭切除后形成的间隙。观察手术前后侧后凸的矫正率、术中脊柱短缩、术后站立位身高变化及术后整体平衡情况。结果:本组患者平均切除1.6个(1～3个)椎体,术中测量脊柱短缩32mm(28～48mm),术后身高测量较术前增加22mm(13～31mm),平均融合范围9.2(6～12)个节段,手术平均用时256min(208～350min),术中平均出血量2250ml(1800～3200ml)。全部病例经过0.5～2.5年随访,侧凸Cobb角矫正率52.3%;后凸畸形矫正率75.1%。所有患者躯干平衡良好,未发现失代偿现象。2例出现一过性脊髓损伤症状,2例出现术中神经根损伤症状,未经特殊处理均基本恢复正常。结论:对于重度成人先天性脊柱侧后凸畸形患者,单纯应用后路经椎弓根扩大“蛋壳”技术行畸形脊椎切除是一种较安全有效的矫治方法。
Objective：To report a technique of transpedicular expanded eggshell technique vertebral column resection （VCR） through single posterior approach and discuss its preliminary results in the treatment of severe congenital rigid kyphoscoliosis in adults.Method：Sixteen aduh,6 males and 10 females with a mean age of 31.8 （range 21.5-44.2 years） years,with severe rigid congenital kyphoscoliosis treated by posterior transpedicular expanded eggshell technique VCR were reviewed retrospectively.Three-dimensional reconstructive images were used for preoperative evaluation of osteotomy levels and accurate placement of pedicle screws.The surgery consisted of one-stage posterior transpedicular eggshell technique,and then expanded the eggshell to the adjacent intervertebra including apex vertebra and both cephal and caudal wedge vertebra combined with their posterior elements,after completion of the VCR,instruments were added to achieve temporary stability. Clinical datas with respect to pre- and post-operative status of each patients were reviewed.Result：An average of 1.6 vertebra were resected.The mean operation time was 256min with average blood loss of 2250ml. Mean 32ram shorten intraoperatively,and 22mm lengthened in standing postopertively were documented.In this group,average follow-up was 1.8 years（range 0.5-2.5 years）.Deformity correction rate was 52.3% in the coro- nal plane and 75.1% in the sagittal plane.Complications were encountered in 4 patients,2 with transient spinal injury and 2 with nerve root injuries intraoperatively（all incomplete ）.Conclusion ： Posterior transpedicular expanded eggshell technique VCR is an effective alternative for severe congenital rigid kyphoscoliosis in adults.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2006年第9期655-658,共4页
Chinese Journal of Spine and Spinal Cord
关键词
脊柱侧后凸
蛋壳技术
脊椎全切术
Kyphoscoliosis
Eggshell technique
Vertebral column resection
