后路全脊椎切除折顶椎管三维同心闭合矫形治疗重度脊柱角状后凸畸形

The unfolding-correcting technique of 3-dimensional close of spinal canal after posterior vertebral col?鄄umn resection in treatment of severe angular kyphotic deformity

中文关键词:  脊柱角状后凸  后路全脊椎切除  折顶矫形  椎管三维同心闭合

英文关键词:Angular kyphotic deformity  Posterior vertebral column resection  Unfolding-correcting technique  3-dimensional close of spinal canal

中文摘要:

  【摘要】 目的：评价后路全脊椎切除折顶矫形治疗重度脊柱角状后凸畸形的安全性和临床初步效果。方法：2004年6月至2008年5月，收治重度脊柱角状后凸畸形患者11例。男4例，女8例，年龄16~42岁，平均27.9岁；其中先天性椎体形成不良6例，胸腰椎结核3例，陈旧性脊柱骨折2例，神经纤维瘤病1例。术前矢状面角状后凸Cobb角82°～150°，平均107.0°；10例合并侧凸畸形，冠状面侧凸Cobb角11°～128°，平均52.7°；6例先天性椎体发育不良中有1例合并神经损害，3例结核中有1例合并神经损害，根据Frankel分级均为D级。均采用顶椎全脊椎切除折顶椎管三维同心闭合矫形术治疗，随访观察治疗效果。结果：手术时间为7.9～14.7h，平均11.1h。术中出血2400~5100ml，平均3866ml。脊髓短缩1.6～2.7cm，平均2.1cm。融合固定节段为8～14节椎体，平均12.5节。矢状面Cobb角由术前平均107.0°矫正至26.1°，矫正率75.6%。冠状面Cobb角由术前平均52.7°矫正至12.3°，矫正率76.7％。躯干矢状偏移距离平均矫正率76.4%。术前2例神经损害者，术后Frankl分级恢复到E级。随访9~61个月，平均25.9个月。所有患者获得良好的骨质愈合，无脊髓损伤，也无矫正度的丢失。结论：全脊椎切除折顶复位术矫正重度脊柱角状后凸畸形疗效满意，椎管三维同心闭合技术保证了截骨面椎管在矢状面、冠状面及水平面的安全闭合。

英文摘要:

  【Abstract】 Objective：To examine the safety and efficacy of unfolding-correcting technique after posterior vertebral column resection to correct severe angular kyphotic deformity.Method：From June 2004 to May 2008，12 patients with severe angular kyphotic deformity treated surgically were included.There were 4 males and 8 females with an average age of 27.9 years（range，16-42 years old）.There were congenital deformity in 6 patients，old tuberculosis in 3，old fracture in 2，and neurofibromatosis in 1.The local deformity was assessed by the Cobb method，the kyphosis angle was from 82° to 150°，with an average of 107.0°.Ten patients also had scoliosis and the Cobb angle in the coronal plane was mean 52.7°（range，11°-128°）.One of six patients of congenital deformity had preoperative neurologic deficits.One of three tuberculosis cases had preoperative neurologic deficits.According to Frankel grading system，two patients were classified as grade D.All patients were surgically treated with the unfolding-correcting technique of 3-dimensional close of spinal canal after posterior vertebral column resection to correct severe angular kyphotic deformity.Result：The average surgery time was 11.1 hours（7.9-14.7h） and average blood loss was 3866ml（2400-5100ml） and average spinal shortening was 2.1cm（1.6-2.7cm）.The average fusion segments was 12.5 ranging from 7 to 14 segments.The Cobb angle in the sagittal plane was corrected from preoperative 107.0° to postoperative 26.1° with a correction rate of 75.6%.The Cobb angle in the coronal plane was corrected from preoperative 52.7° to postoperative 12.3°，with correction rate 76.7％.76.4% of sagittal trunk shift was corrected.Two cases with preoperative neurologic deficits were recovered from grade D to grade E.All patients were followed up for 9-61 months（mean 25.9 months）.Bony fusion was achieved in all patients.There were no spinal cord injury and correction loss.Conclusion：It is satisfactory to treat severe angular kyphotic deformity with the unfolding-correcting technique of 3-dimensional close of spinal canal after posterior vertebral column resection.The 3-dimensional closing technique can provide a safely closing of spinal canal in the sagittal，coronal and transverse planes at the osteotomic level.