摘要
目的评估后路经椎弓根截骨矫形部分半椎体保留治疗先天性半椎体所致脊柱侧凸畸形的临床疗效。方法共18例先天性半椎体合并脊柱侧凸患者纳入随访研究,平均年龄16.17岁(14～21岁),术前测量半椎体所致脊柱畸形的节段性主弯Cobb角45.39°±6.81°,头侧代偿弯Cobb角27.5°±2.71°,尾侧代偿弯Cobb角为26.44°±6.85°,顶椎偏距为4.28±0.58cm,节段性后/前凸角度为14.11°±18.07°。所有病例均采用后路一期经半椎体椎弓根截骨,双侧固定矫正侧凸畸形。随访时间为14.17±6.56个月。综合评估影像学、临床疗效以及并发症的情况。结果手术时间为2.82±0.74h,术中失血量317.22±65.15ml。术后节段性主弯Cobb角为11.33°±4.68°,矫正34.06°±7.88°,末次随访14.61°±4.96°;头侧代偿弯Cobb角为8.72°±1.44°,矫正18.78°±3.17°,末次随访18.78°±3.17°;尾侧代偿弯Cobb角为7.98°±1.82°,矫正18.47°±5.83°,末次随访18.47°±5.83°;节段性后/前凸角为-1.94°±12.35°,矫正14.94°±10.18°,末次随访-1.5°±12.67°。顶椎偏距的矫正为2.31±0.52cm,末次随访2.1±0.24cm。术中没有血管、神经损伤、骨折等重大并发症发生,术后没有发生冠状面和矢状面的失代偿。结论后路半椎体经椎弓根截骨矫形能有效矫正轻、中度先天性半椎体所致脊柱侧凸畸形,缩短手术时间,创伤小,减少术中失血量,矫形效果满意,所选病例骨骼发育相对成熟者,避免矫形丢失。
Objective To evaluate the clinical effect of transpedicular wedge osteotomy and partial hemivertebraereservation for correction of congenital spinal deformity.Methods A total of 18 consecutive patients with congenital spinaldeformity（mean age 16.17 years,range 14～21） were involved in this study.Before surgery,the mean Cobb angle was45.39°±6.81°for the segmental main curve,27.5°±2.71°for the compensatory cranial curve,26.44°±6.85°for thecompensatory caudal curve,14.11°±18.07°for the segmental kyphosis/lordosis.The mean apical vertebral translationwas 4.28±0.58cm.Radiographic and clinical results and complications were assessed.The follow-up period was 14.17±6.56months.Results The surgical time was 2.82±0.74 hours and blood loss during the procedure was 317.22±65.15ml.After surgery,the mean Cobb angle,the amount of correction and the final assessment was 11.33°±4.68°,34.06°±7.88°and 14.61°±4.96°for the segmental main curve,8.72°±1.44°,18.78°±3.17°and 18.78°±3.17°for the compensatory cranial curve,7.98°±1.82°,18.47°±5.83°and 18.47°±5.83°for the compensatory caudalcurve,-1.94°±12.35°,14.94°±10.18°and - 1.5°±12.67°for the segmental kyphosis/lordosis.The mean apicalvertebral translation was 2.31±0.52cm after surgery,and 2.1±0.24cm at final assessment.No nerve,vascular injuryand stress fracture.No coronal decompensation.Conclusion Hemivertebra wedge osteotomy and partial hemivertebraereservation by posterior approach only is safe and effective for correction of mild and moderate congenital spinal deformity.It can save operation time and is less invasive.The amount of blood loss during modified procedure was less.The rates ofcorrection loss were low for the relative maturity of spine.
出处
《中国骨与关节外科》
2011年第4期270-274,共5页
Chinese Journal of Bone and Joint Surgery
