后路半椎体切除矫治半椎体所致脊柱侧后凸畸形Primary clinical results of posterior hemivertebra resection in the treatment of congenital kyphoscoliosis
曹鹏克;吴广良;侯秀伟;张云飞;徐永辉;裴勇;陈宏峰;
摘要(Abstract):
[目的]评价后路半椎体切除术治疗半椎体所致脊柱侧后凸畸形的临床效果。[方法]2000年5月~2005年11月,采用后路半椎体切除及矫形固定融合术治疗14例完全分节半椎体所致脊柱侧后凸畸形患者。年龄2.5~14.4岁,平均7.4岁,半椎体均为侧后方半椎体,其中胸椎7例,腰椎7例。[结果]手术时间2~7 h,平均4.7h,术中出血量150~2 500 m l,平均560 m。l固定节段2~8个椎体,平均3.5。术后随访6~36个月。平均15.6个月。术后站立位脊柱正侧位X线片示冠状面Cobb's角由术前46.2°矫正到17.3°,平均矫正率62.6%,矢状面Cobb's角由术前48.3°矫正至术后16.2°,平均矫正率68.7%。终末随访时冠状面Cobb's角平均21.7°,丢失4.4°,矢状面Cobb's角平均18.7°,丢失2.5°。围手术期并发症包括:伤口愈合不良2例,术中术后椎弓根螺钉切割椎体2例。[结论]后路半椎体切除可直接去除致畸因素,在冠状面及矢状面均获得良好的矫形效果,与前后路手术相比可缩短手术时间,减少创伤,适用于从胸段到腰段的半椎体畸形。
关键词(KeyWords): 半椎体畸形;脊柱侧后凸;脊柱融合术;内固定器
基金项目(Foundation):
作者(Author): 曹鹏克;吴广良;侯秀伟;张云飞;徐永辉;裴勇;陈宏峰;
Email:
DOI:
参考文献(References):
- [1]M cMasterM J,David CV.Hem ivertebra as a cause of scoliosis:a studyof 104 patients[J].J Bone Joint Surg(B r),1986,68:588-595.
- [2]Nasca R J,Stilling FH 3rd,SteelHH.Progression of congen ital scoliosisdue to hem ivertebrae and hem ivertebrae w ith bars[J].J Bone JointSurg(Am),1975,57:456-466.
- [3]Shono Y,Abum i K,Kaneda K.One-stage posterior hem ivertebra resec-tion and correction using segm ental posterior instrum entation[J].Sp ine,2001,26:752-757.
- [4]RufM,Harm s J.Hem ivertebra resection by a posterior approach:inno-vative operative techn ique and first resu lts[J].Sp ine,2002,27:1116-1123.
- [5]刘祖德,贾连顺,袁文,等.胸腰椎半椎体畸形的手术治疗[J].中国矫形外科杂志,2002,10(13):1305-1307.
- [6]李明,倪春鸿,朱晓东,等.后路半椎体切除节段固定矫正侧后凸畸形疗效初步观察[J].中国矫形外科杂志,2004,12(5):338-341.
- [7]Callaghan BC,Geor-gopou los G,E ilert RE.Hem ivertebral excision forcongen ital scoliosis[J].J Ped iar O rthop,1997,17(1):96-99.
- [8]仉建国,邱贵兴,于斌,等.后路半椎体切除术治疗先天性脊柱侧后凸的初步结果[J].中华骨科杂志,2006,26(3):156-160.
- [9]RufM,Harm s J.Posterior hem ivertebra resection w ith transped icu larinstrum entation:early correction in ch ildren aged 1 to 6 years[J].Sp ine,2003,28:2132-2138.