摘要
目的:评价经后路凸侧椎板楔形截骨经肋椎关节松解胸椎间隙矫形治疗青少年重度脊柱侧后凸畸形的安全性和早期临床效果。方法:2014年5月~2016年12月对我院15例青少年重度脊柱侧后凸患者行经后路凸侧椎板楔形截骨经肋椎关节松解胸椎间隙手术治疗,术前仅1例严重脊柱侧后凸患者行头盆环牵引。男6例,女9例,年龄13~18岁(16.1±1.6岁)。其中先天性脊柱侧后凸3例,特发性11例,神经纤维瘤病性1例。术前侧凸Cobb角82°~144°(102.5°±17.6°),侧凸的柔韧性为6.4%~28.5%[(21.56±5.70)%];后凸50°~95°(68.1°±15.3°),冠状位躯干偏移距离(C7中垂线与骶骨中垂线距离)2.0~6.8cm(3.40±1.37cm)。术前四肢肌力及感觉均正常。观察治疗效果。结果:椎板楔形截骨5.20±0.56个(4~6个),松解椎间隙5.20±0.56个(4~6个),手术时间6.1~7.9h(7.00±0.51h),术中出血量1050~2500ml(1450.0±521.3ml)。术后侧凸Cobb角18°~40°(28.0°±6.6°),矫正率72.5%;后凸22°~42°(27.8°±6.1°),矫正率58.4%;冠状位躯干偏移距离0~2cm(0.85±0.74cm),矫正率72.8%。随访25~41个月(33.1±5.4个月)。末次随访时侧凸Cobb角19°~43°(30.0°±6.9°),矫正率70.6%;后凸22°~42°(28.6°±6.5°),矫正率57.2%;冠状位躯干偏移距离0.2~2.3cm(1.10±0.72cm),矫正率71.3%。无胸膜破裂,无假关节形成,无内固定断裂及松动,矫正度无显著丢失。1例患者术前骨盆牵引发生钉道感染,经局部换药及抗生素应用,2周后感染控制;1例术后第3天发生十二指肠系膜上动脉综合征,采取禁食水、持续胃肠减压、维持水电解质平衡、左侧卧位,术后2周痊愈;1例T4左侧椎弓根螺钉侵入椎管压迫神经,术后5h发生左下肢不完全性瘫痪,术后8h去除T4左侧椎弓根螺钉,术后5个月左下肢功能完全恢复。结论:采用后路凸侧椎板楔形截骨经肋椎关节松解胸椎间隙治疗青少年重度脊柱侧后凸畸形,不需要剥离椎体侧方胸膜,手术解剖层次表浅和创�
Objectives:To evaluate the early clinical efficacy and safety of posterior convex lamina wedge osteotomy and thoracic intervertebral disc space release through costovertebral joints for severe and rigid kyphoscoliosis in adolescents.Methods:From May 2014 to December 2016,15 patients with severe rigid kyphoscoliosis were treated with posterior convex lamina wedge osteotomy and thoracic intervertebral space release through costovertebral joints at our hospital,and only one of them underwent halo-pelvic traction before operation.There were 6 males and 9 females,aged 13 to 18 years,with a mean age of 16.1±1.6 years.Among them,3 patients were of congenital vertebral deformity,11 were of neglected idiopathic scoliosis,and 1 was of type I neurofibromatosis.The mean preoperative scoliosis Cobb angle was 102.5°±17.6°(ranged 82°to 144°).The mean flexibility was(21.56±5.70)%(range,6.4%to 28.5%).And the mean preoperative sagittal kyphosis angle was 68.1°±15.3°(ranged 50°to 95°).The coronal balance(distance between coronal C7 centroid plumb line and the central sacral vertical line)was 2.0 to 6.8cm,with a mean distance of 3.40±1.37cm.The muscle strength and sensation of extremities of all the patients were normal before operation.Results:The average number of wedge osteotomy of convex vertebral lamina was 5.20±0.56 and the release space was 5.20±0.56.The operative time ranged from 6.1 to 7.9 hours,which was averaged 7.00±0.51 hours.Intraoperative blood loss was 1050ml to 2500ml,with a mean of 1450.0±521.3ml.The mean postoperative scoliosis Cobb angle was 28.0°±6.6°(range,18°to 40°),and the correction rate was 72.5%.The mean postoperative sagittal kyphosis angle was 27.8°±6.1°(ranged 22°to 42°),and the correction rate was 58.4%.The mean coronal balance was 0.85±0.74cm(range,0 to 2cm),and the correction rate was 72.8%.The mean follow up period was 33.1±5.4 months(range,25 to 41 months).At the most recent follow-up,the scoliosis Cobb angle was 30.0°±6.9°(range,19°to 43°),and the correction rate
作者
李超
于海洋
付青松
李海江
尹稳
王伟
邹欣欣
张伟
刘彬
LI Chao;YU Haiyang;FU Qingsong(Department of Orthopedics,Fuyang People's Hospital,Anhui Medical University,Fu-yang,236000,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2021年第11期1016-1025,共10页
Chinese Journal of Spine and Spinal Cord
基金
安徽省科技重点攻关项目(12010402121)。
关键词
重度脊柱侧后凸
青少年
凸侧椎板楔形截骨
肋椎关节
胸椎间隙松解
Severe kyphoscoliosis
Adolescent
Convex lamina wedge osteotomy
Costovertebral joints
Thoracic intervertebral space release
