摘要
目的对严重脊柱侧后凸后路全脊椎截骨术后残留后凸畸形的危险因素进行分析，并提出相应的处理策略。方法2002年4月至2006年1月，采用后路经椎弓全脊椎截骨术矫治严重脊柱侧后凸畸形患者75例，男39例，女36例；年龄10～32岁，平均16．9岁。术前侧凸Cobb角平均72°（51°～130°），后凸Cobb角平均82°（69°～147°）。7例术前存在不同程度的下肢不全性瘫痪症状。治疗策略：一期后路经椎弓顶椎区全脊椎截骨、矫形内固定术。根据术后残留后凸的程度，75例中有28例又进行了二期前路凹侧自体胫骨条支撑融合术（A组，11例）或凸侧植骨融合术（B组，17例）。结果后路截骨术后28例残留后凸，其原因为：术前后凸过大（〉100°）11例，同侧连续半椎体5例，半椎体伴分节不良4例，凹侧截骨不充分3例，肋骨头切除不足2例，人为残留3例。全组无死亡，无感染。28例残留后凸患者中22例获得平均21个月的随访，A组1例术后12个月因支撑胫骨条骨折而发现假关节，固定棒断裂；1例存在假关节可能，其余病例均达到骨性融合。1例术后因外伤发生原胫骨取骨处骨折。B组病例均骨性融合，无一例发生脱钩或断棒等内固定并发症。结论对严重脊柱侧后凸后路全脊椎截骨术后残留较大后凸畸形的患者，二期行前路凹侧支撑或凸侧植骨融合术，可减少术后远期发生内固定失败、畸形加重及神经损害等并发症。
Objective To explore the risk factors of residual kyphosis after total vertebral osteotomy for severe kyphoscoliosis, and to present further surgical strategy. Methods From April 2002 to January 2006, 75 patients with severe kyphoscoliosis deformity were treated with posterior total vertebral osteotomy. Tile pre-operative scoliosis Cobb angle was 72°（51°-130°） and kyphosis Cobb angle was 82°（69°-147°）. Tilere were 7 patients with neurological deficits pre-operatively. All the patients received primary posterior total vertebral osteotomy and instrumentation. 28 out of 75 patients underwent secondary anterior strut graft- ing on the concave side （group A） or anterior interbody autografting on the convex side （group B） according to the residual kyphosis after posterior operation. Results There were 11 cases in group A and 17 cases in group B. Tile risk factors of the residual kyphosis after posterior total vertebral osteotomy were as follows： hyperkyphosis（〉100°） in 11 patients, continuous convex hemivertebrae in 5, hemivertebrae combined with failure of vertebral body segmentation in 4, insufficient osteotomy on the concave side in 3, insufficient rib head resection in 2, and partial correction to avoid spinal cord compression in 3.22 patients were followed up for an average period of 21 months. No death and infection occurred. In group A, one patient developed pseu- darthrosis and rod failure due to the tibial strut fracture, one patient diagnosed as suspicious pseudarthrosis, and other patients achieved bony fusion. One patient suffered from tibia fracture in donor area due to trauma. Patients in group B achieved bony fusion and no implant failure was found. Conclusion For the patients with residual kyphosis after total vertebral osteotomy, additional anterior strut grafting on the concave side or anterior interbody autografting on the convex side could reduce the implant failure, correction loss and neurological complications.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2008年第1期14-19,共6页
Chinese Journal of Orthopaedics
基金
国家自然科学基金（30672131）
关键词
脊柱侧凸
截骨术
畸形
Scoliosis
Osteotomy
Abnormalities
