上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

后路半椎体切除多棒分段矫治中、重度僵硬性先天性脊柱侧后凸畸形

李 波1，余 雨1，卢旻鹏1，屈一鸣1，钱邦平2   

  1. 1.重庆医科大学附属永川医院脊柱外科， 重庆 402160； 2.南京大学医学院附属鼓楼医院脊柱外科， 南京 210008
  • 出版日期:2014-04-28 发布日期:2014-05-13
  • 作者简介:李波（1974—）， 男， 副教授， 副主任医师， 硕士， 硕士生导师; 电子信箱: cqeylibo@163.com。

Treatment of medium-to-severe rigidity congenital kyphoscoliosis by posterior hemivertebral resection and segmental multi-rod instrumentation

LI Bo1, YU Yu1, LU Min-peng1, QU Yi-ming1, QIAN Bang-ping2   

  1. 1.Department of Spinal Surgery, the Affiliated Yongchuan Hospital of Chongqing Medical University， Chongqing 402160, China； 2.Department of Spinal Surgery, the Affiliated Drum Tower Hospital of Medical School, Nanjing University, Nanjing 210008, China
  • Online:2014-04-28 Published:2014-05-13

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摘要：

目的 评价一期经后路半椎体切除及多棒分段矫形治疗单个半椎体引起的中、重度僵硬性脊柱侧后凸畸形的初期手术效果。方法 17例中、重度僵硬性先天性脊柱侧后凸畸形患者均经一期后路半椎体切除及多棒分段矫形内固定治疗，其中T10 2例，T11 4例，T12 5例，L1 3例，L2 3例；术前侧凸Cobb 角为（67.9±8.2）°，后凸Cobb角为（73.0±10.6）°。结果 所有患者安全完成手术，无死亡及神经损伤并发症发生。手术时间4.0～7.5 h，平均5.6 h；术中出血量500～3 000 mL，平均1 050 mL。1 例术中切除肋骨小头时引起胸膜撕裂，发生血气胸，行胸腔闭式引流，1周后痊愈；随访时间12～35个月，平均19.4个月。随访X线片证实植骨均融合，未发现内固定物松动断裂、假关节形成等并发症。术后1周和末次随访时侧凸及后凸Cobb角与术前比较均明显改善，差异有统计学意义（P<0.05）。结论 一期经后路半椎体切除及多棒分段矫治单个半椎体引起的中、重度僵硬性先天性脊柱侧后凸畸形，方法有效且可行，在矫正脊柱侧弯的同时有效矫正脊柱后凸畸形。

关键词: 先天性侧后凸, 后路半椎体切除, 僵硬

Abstract:

Objective To evaluate the early clinical outcome of one-stage posterior hemivertebral resection and segmental multi-rod instrumentation for the treatment of medium-to-severe rigidity congenital kyphoscoliosis caused by a single hemivertebrae. Methods Seventeen patients with medium-to-severe rigidity congenital kyphoscoliosis were surgically treated by the posterior hemivertebral resection and segmental multi-rod instrumentation. Hemivertebrae were sited in T10(2 cases), T11(4 cases), T12(5 cases), L1(3 cases), and L2(3 cases). The preoperative scoliotic Cobb angles were (67.9±8.2)° and kyphotic Cobb angles were (73.0±10.6)°. Results All patients underwent surgeries safely and there were no death or neurological injuries occurred. The operation time was 4.0-7.5 h (averaged 5.6 h) and the perioperative bleeding was 500-3 000 mL (averaged 1 050 mL). One patient suffered from left pleura tearing during capitulum costae resection and incurred hemopneumothorax. The patient was treated by chest cavity closed drainage and recovered completely after one week. All cases were followed up for 12-35 months (averaged 19.4 months). Bony fusion was achieved in all patients and no pseudoarthrosis and implant failure was observed. The Cobb angles of scoliosis and kyphosis after one week of operations and at the time of the last follow-up were much better than those before the operations. The differences were statistically significant (P<0.05). Conclusion The one-stage posterior hemivertebral resection and segmental multi-rod instrumentation is feasible and effective in correcting scoliosis and kyphosis for the treatment of medium-to-severe rigidity congenital kyphoscoliosis caused by a single hemivertebrae.

Key words: congenital kyphoscoliosis, posterior hemivertebra resection, rigid