摘要
目的综述脊柱结核角状后凸畸形手术治疗现状,以期为临床提供参考。方法广泛查阅国内外近年关于脊柱结核角状后凸畸形手术治疗文献,从手术指征、手术禁忌证、手术入路及截骨术式选择、围术期管理等方面进行总结。结果脊柱角状后凸畸形是脊柱结核患者常见并发症,后凸畸形如逐步进展,易造成神经功能损害、恶化以及迟发性瘫痪等严重后果,需要手术干预。目前脊柱结核角状后凸畸形矫形手术入路包括前路、后路以及前后联合入路。对于脊髓受压严重、后凸畸形程度轻的患者,可以采用前路手术;后凸畸形严重但神经功能受损不严重患者,可以采用后路手术;若要兼顾椎管减压和矫形则可以选择前后联合入路。后凸畸形截骨矫形术式包括Smith-Peterson截骨(Smith-Peterson osteotomy,SPO)、经椎弓根截骨(pedicle subtraction osteotomy,PSO)、全脊柱切除(vertebral column resection,VCR)、脊柱去松质骨截骨(vertebral column decancellation,VCD)、后路脊柱切除(posterior vertebral column resection,PVCR)、经畸形复合椎截骨(deformed complex vertebral osteotomy,DCVO)、Y形截骨。SPO、PSO手术难度较低、手术风险也较小,可以提供15°~30°矫正效果。VCR、PVCR是截骨矫形代表术式,全脊柱切除后凸矫形可达50°,适用于严重角状后凸畸形患者。VCD、DCVO、Y形截骨是近年新兴术式,手术风险相对VCR有所降低,治疗效果也有不同程度提高。术后康复是围术期重要一环,应给予重视。结论脊柱结核角状后凸畸形手术方式的选择尚未达成共识,截骨矫形手术创伤大一直是临床关注问题,应尽可能在保证手术效果的同时选择创伤较小的手术方式。
Objective To review current status of surgical treatment for angular kyphosis in spinal tuberculosis and provide reference for clinical treatment.Methods The literature on the surgical treatment for angular kyphosis of spinal tuberculosis in recent years was extensively reviewed and summarized from the aspects of surgical indications,surgical contraindications,surgical approach,selection of osteotomy,and perioperative management.Results Angular kyphosis of spine is a common complication in patients with spinal tuberculosis.If kyphosis progresses gradually,it is easy to cause neurological damage,deterioration,and delayed paralysis,which requires surgical intervention.At present,surgical approaches for angular kyphosis of the spine include anterior approach,posterior approach,and combined anterior and posterior approaches.Anterior approach can be performed for patients with severe spinal cord compression and small kyphotic Cobb angle.Posterior approach can be used for patients with large kyphotic Cobb angle but not serious neurological impairment.A combined anterior and posterior approaches is an option for spinal canal decompression and orthosis.Osteotomy for kyphotic deformity include Smith-Peterson osteotomy(SPO),pedicle subtraction osteotomy(PSO),vertebral column resection(VCR),vertebral column decancellation(VCD),posterior vertebral column resection(PVCR),deformed complex vertebral osteotomy(DCVO),and Y-shaped osteotomy.SPO and PSO are osteotomy methods with relatively low surgical difficulty and low surgical risks,and can provide 15°-30°angular kyphosis correction effect.VCR or PVCR is a representative method of osteotomy and correction.The kyphosis correction can reach 50°and is suitable for patients with severe angular kyphosis.VCD,DCVO,and Y-shaped osteotomy are emerging surgical techniques in recent years.Compared with VCR,the surgical risks are lower and the treatment effects also improve to varying degrees.Postoperative recovery is also a very important part of the perioperative period and should be
作者
郑舒鑫
宋跃明
汪雷
ZHENG Shuxin;SONG Yueming;WANG Lei(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2024年第4期487-492,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
脊柱结核
角状后凸畸形
手术治疗
Spinal tuberculosis
angular kyphosis
surgical treatment
