后路截骨矫形治疗低龄先天性脊柱后凸畸形的疗效分析

The posterior surgical correction of congenital kyphosis (under 10 years old)

中文关键词:  脊柱后凸畸形  截骨术  后路矫形  先天性畸形  椎弓根螺钉

英文关键词:Kyphosis  Osteotomy  Posterior correction  Congenital deformity  Pedicle screws

中文摘要:

  【摘要】 目的：评价经后路截骨内固定术治疗低龄（10岁以下）先天性脊柱后凸畸形的临床效果。方法：2009年10月～2013年5月采用经后路截骨椎弓根螺钉内固定治疗先天性脊柱后凸患者17例，男6例，女11例，手术时年龄64±21个月（37～109个月）。根据Winter分型：Ⅰ型8例，Ⅱ型4例，Ⅲ型5例。后凸顶椎均位于T10～L2之间。5例伴神经系统畸形。8例行后路椎体切除（PVCR），5例行经椎弓根截骨（PSO），4例行Ponte截骨，截骨后均采用后路自体骨或同种异体骨植骨椎弓根螺钉内固定。统计手术时间、术中出血量及手术并发症，观察矫形效果、内固定并发症、椎体融合情况等。结果：手术时间210±46min（130～300min），出血量650±330ml（200～1300ml）；固定融合节段4.9±0.8个（4～6个）。随访34.7±10.4个月（24～51个月），矢状面节段性后凸Cobb角由术前61.5°±14.3°（42°～92°）矫正至术后20.7°±9.0（5°～42°），矫正率为（66.3±8.7）％，末次随访时为17.5°±9.5°（1°～36°），矫正率为（71.5±10.7）％，手术后Cobb角得到显著性改善（P＜0.01）；矢状面平衡术前为-41.3±31.8mm，术后为-43.5±30.4mm，与术前比较无显著性变化（P＞0.05），末次随访时为-25.6±26.7mm，较术前明显改善（P＜0.05）。术后出现双下肢无力1例，排尿困难1例，术后2周恢复。术前腰背痛5例、排尿异常1例，术后6个月症状好转。1例患者术后7个月出现近端交界性后凸。随访期间未发现假关节及内固定相关并发症。结论：对低龄先天性脊柱后凸畸形患者早期行后路截骨、椎弓根螺钉内固定可显著改善后凸畸形，但术后不能立即达到脊柱矢状面平衡，而是在术后随生长发育逐渐恢复矢状面平衡。

英文摘要:

  【Abastract】 Objectives: To evaluate the outcomes of operative results of congenital kyphosis patients who were under 10 years old and underwent posterior osteotomies. Methods: From October 2009 to May 2013, 17 congenital kyphosis patients(6 males, 11 females) who underwent posterior osteotomy in our institution were investigated restrospectively. The average age was 64±21 months(37-109 months) at operation. According to Winter classification, 8 cases were type Ⅰ, 4 cases were type Ⅱ, and 5 cases were type Ⅲ. The apex vertebrae were located between T10 and L2 in all patients. Associated intraspinal anomalies were involved in 5 cases. Operation time, intraoperative blood loss and perioperative complications were recorded. The correct effect, instrumentation related complication and spinal fusion were measured. Results: The mean operation time was 210±46min(range, 130-300min)． The mean blood loss was 650±330ml(range, 200-1300ml)． The mean fusion level was 4.9±0.8(range, 4-6)． The mean follow-up period was 34.7±10 months(range, 24-51 months)． The average preoperative regional kyphosis angle was 61.5°±14.3°(42°-92°), which decreased to 20.7°±9.0°(5°-42°) postoperatively with a correction rate of (66.3±8.7)％, and to 17.5°±9.5°(1°-36°) with a correction rate of (71.5±10.7)％ at last follow-up. There was significant improvement of regional kyphosis postopratively and at last follow-up(P＜0.01). The sagittal balance was -41.3±31.8mm preoperatively, -43.5±30.4mm postoperatively and -25.6±26.7mm at last follow-up. There was no statistical difference in sagittal balance at pre- and postoperation(P＞0.05), while the sagittal balance at last follow-up showed significant improvement compared with that befroe opetation(P＜0.05). Complications after surgery included muscle weakness of bilateral lower limbs in one case and dysuria in one case, and both healed within 2 weeks． Five cases with back pain and one case with urinary incontinence before operation had relieved 6 months after operation. One case developed proximal junctoinal kyphosis 7 months after operation. No pseudarthrosis and implant related complications happened during follow-up. Conclusions: Early spinal osteotomy and pedicle screws fixation can achieve compatible and satisfactory correction results on congenital kyphosis. The spinal saggital balance cannot be achieved immediately after surgery in the majority of cases, but they have a tendency of rebalance during the following years.