后路全脊椎截骨联合钛网支撑治疗合并神经症状的重度脊柱角状后凸畸形

Posterior osteotomy and mesh cage support for severe and rigid angular kyphosis complicated with neurologic deficits

中文关键词:  角状后凸畸形  后路全脊椎截骨  并发症

英文关键词:Angular kyphosis  Posterior vertebral column resection  Complication

中文摘要:

  【摘要】 目的：探讨经后路全脊椎截骨联合钛网支撑治疗合并神经症状的重度脊柱角状后凸畸形的临床疗效及手术安全性。方法：2006年1月～2009年11月我院采取后路全脊椎截骨联合钛网支撑治疗术前合并神经症状的重度脊柱角状后凸畸形患者15例，脊柱后凸Cobb角85°～150°，平均112.8°，C7铅垂线距S1后上缘距离－36～48mm，平均30.4mm，脊髓功能Frankel分级B级3例，C级4例，D级8例。随访观察神经功能变化情况；记录围手术期相关并发症。结果：手术时间平均331.4min（240～470min），术中出血量平均2196.7ml（1200～4000ml），随访时间平均28.0个月（20～35个月），脊柱后凸Cobb角术后平均42.4°，末次随访时平均44.5°，矫正率为64.1%，丢失率为6.0%；C7铅垂线距S1后上缘距离术后平均10.4mm，末次随访时平均7.8mm，矫正率为66.0%；末次随访时除1例Frankel分级D级患者加重为A级外，余病例神经功能均较术前有恢复。围手术期共发生5例次并发症，其中神经并发症3例次，除1例神经完全损伤无恢复外，余2例经营养神经及高压氧治疗后神经功能均恢复正常；非神经并发症2例次，包括1例胸腔积液，1例切口感染，经对症处理后均治愈。所有患者内固定物无移位及断裂，植骨融合良好。结论：全脊椎截骨在矫形的同时有效解除了顶点区脊髓压迫，促进了术后神经功能恢复，但有加重神经损伤的风险。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy and safety of posterior osteotomy and mesh cage support for severe and rigid angular kyphosis complicated with neurologic deficits. Methods: From January 2006 to November 2009, 15 patients suffering from rigid angular kyphosis complicated with neurologic deficits underwent posterior osteotomy and mesh cage support in our institute. The mean Cobb angle of kyphosis was 112.8°, Sagittal vertical axis(SVA) was 30.4mm. According to Frankel grading system, 3 patients were classified as grade B, 4 as grade C, 8 as grade D. Frankel grade was measured before and after operation. The complications were recorded retrospectively. Results: The average surgery time was 331.4min (240-470min) and the average blood loss was 2096.7ml(1200-4000ml). The average follow-up time was 28.0 months(20-35 months). The post-op kyphosis was 42.4° with a correction rate of 64.1%, and the kyphosis was 44.5° at final follow-up, with a loss rate of 6.0%. The post-op average SVA was 10.4mm with a correction rate of 66.0%. A total of 5 complications occurred in perioperative period, including 3 neurological cmplications and 2 non-neurological cmplications. 1 case grading Frankel had changed from D to A achieved no recover till the final follow-up, another 2 cases Frankel grade had changed to normal by neurotrophic and hyperbaric oxygen therapy. Another 2 cases who observed in pleural effusion and local infection, they were healed with appropriated treatment. Bony fusion was achieved in all patients, there was no correction lose. Conclusions: Posterior osteotomy can ensure satisfactory correction and decompression to the spinal cord, however risk of neurological injury must be taken into consideration.