改良型经椎弓根截骨治疗小儿胸腰段治愈型结核伴后凸畸形Modified pedicle subtraction osteotomies(mPSO) for thoracolumbar post- tubercular kyphosis in pediatric patients
张宏其;陈勇;郭超峰;高琪乐;刘金洋;唐明星;胡雄科;
摘要(Abstract):
[目的]通过临床病例回顾性研究,对改良型经椎弓根截骨治疗伴后凸畸形的小儿胸腰段治愈型结核的疗效进行系统评估。[方法]回顾分析2008年1月~2012年7月间进行手术治疗的36例小儿胸腰段治愈型结核伴后凸畸形的患者,通过对比C7铅垂线与S1后上角距离,胸腰段Cobb角、VAS及ODI评分,评价患者畸形矫形效果及生活质量,评估改良型经椎弓根截骨治疗小儿胸腰段治愈型结核伴后凸畸形的疗效。[结果]本组36例患者均得到随访,随访时间18~56个月,平均41个月。所有患儿伤口均一期愈合。无神经功能损伤等严重并发症。C7铅垂线与S1后上角距离术前为(105.0±11.40)mm,术后纠正为(38.0±5.91)mm,胸腰段Cobb角由术前(60.60±3.70)°缩小为术后的(19.7±2.2)°。患者畸形得到较好的矫正,重建了矢状位平衡。VAS及ODI评分术前术后对比差异均有统计学意义(P<0.05),患者生活质量得到明显改善。[结论]采用改良型经椎弓根截骨术(MPSO)治疗小儿胸腰段治愈型结核伴后凸畸形矫形效果明显,手术时间短,手术风险相对较小,后凸矫果好,术后并发症少,融合率高,患儿满意度高。
关键词(KeyWords): 改良经椎弓根截骨;小儿;胸腰段;治愈型结核;后凸畸形
基金项目(Foundation): 国家自然科学基金资助项目(编号:81271940);; 湖南省自然科学基金重点项目(编号:12JJ2043)
作者(Author): 张宏其;陈勇;郭超峰;高琪乐;刘金洋;唐明星;胡雄科;
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参考文献(References):
- [1]Rajasekaran S.Kyphotic deformity in spinal tuberculosis and its managemen[J].Int Orthop,2012,36(2):359-365.
- [2]Donald P.The chemotherapy of osteo-articular tuberculosis with recommendations for treatment of children[J].J Infection,2011,62(6):411-439.
- [3]张宏其,王瑶,刘少华,等.单纯经后路全脊椎切除治疗胸段治愈型结核并重度角状后凸畸形[J].中国骨与关节损伤杂志,2010,25(11):972-924.
- [4]王正雷,高吉昌,贾丹兵,等.成人脊柱后凸畸形后路全脊椎截骨矫形手术1 200例报告[J].中国矫形外科杂志,2011,19(15):1258-1260.
- [5]Kim KT,Lee SH,Suk KS,et al.Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies:a retrospective review of 140 patients[J].Spine,2012,37(19):1667-1675.
- [6]Rajasekaran S,Vijay K,Shetty AP.Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine:a 3-year follow-up of 17 patients[J].Eur Spine J,2010,19(4):583-592.
- [7]Lenke LG,O’Leary PT,Bridwell KH,et al.Posterior vertebral column resection for severe pediatric deformity:minimum two-year follow-up of thirty-five consecutive patients[J].Spine,2009,34(20):2213-2221.
- [8]Zhang HQ,Huang J,Guo CF,et al.Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis[J].Eur Spine J,2014,23(1):234-241.
- [9]刘少华,张宏其,刘金洋,等.后路经椎弓根闭合性楔形截骨治疗强直性脊柱炎所致脊柱后凸畸形[J].中国矫形外科杂志,2012,20(17):1556-1559.