CAJ | 학술논문

目的评价节段性椎弓根钉系统治疗伴发脊髓空洞的脊柱侧凸的手术疗效.方法应用节段性椎弓根钉系统治疗伴发脊髓空洞的脊柱侧凸35例.合并Chiari Ⅰ型畸形12例(34.3%).典型侧凸18例,不典型侧凸 17例.所有患者术前均未接受任何针对脊髓卒洞的治疗措施.手术分组:(1)一次手术组(30例):患者手术年龄>10岁,一次性后路节段性椎弓根钉系统矫形内固定植骨融合术.(2)二次手术组(5例):患者年龄≤10岁,一期手术行可自行延长的节段性椎弓根钉系统矫形手术,4～6年后行二期矫形内同定植骨融合术.结果术前冠状面主弯Cobb角平均66.5°(32°～121°);术后平均22.6°(0°～78°),平均矫正率69.4%(31%～100%);平均随访58.4(13～113)个月,末次随访时冠状面主弯Cobb角3°～78°,平均25.9°.最终矫正率63.9%.6例随访时出现追加现象,其中5例融合下端椎没有融合至稳定椎.术后出现腹壁反射消失1例,浅感觉减退范围扩大1例,未予处理.结论对于伴发未经治疗的非扩张型脊髓窄洞的脊柱侧凸,如果术前无或仅伴随轻微神经损害症状,可以直接采用后路节段性椎弓根钉系统进行矫形治疗.建议对这类脊柱侧凸远端应融合至稳定椎.
목적 평개절단성추궁근정계통치료반발척수공동적척주측철적수술료효.방법 응용절단성추궁근정계통치료반발척수공동적척주측철35례.합병Chiari Ⅰ형기형12례(34.3%).전형측철18례,불전형측철 17례.소유환자술전균미접수임하침대척수졸동적치료조시.수술분조:(1)일차수술조(30례):환자수술년령>10세,일차성후로절단성추궁근정계통교형내고정식골융합술.(2)이차수술조(5례):환자년령≤10세,일기수술행가자행연장적절단성추궁근정계통교형수술,4～6년후행이기교형내동정식골융합술.결과 술전관상면주만Cobb각평균66.5°(32°～121°);술후평균22.6°(0°～78°),평균교정솔69.4%(31%～100%);평균수방58.4(13～113)개월,말차수방시관상면주만Cobb각3°～78°,평균25.9°.최종교정솔63.9%.6례수방시출현추가현상,기중5례융합하단추몰유융합지은정추.술후출현복벽반사소실1례,천감각감퇴범위확대1례,미여처리.결론 대우반발미경치료적비확장형척수착동적척주측철,여과술전무혹부반수경미신경손해증상,가이직접채용후로절단성추궁근정계통진행교형치료.건의대저류척주측철원단응융합지은정추.
Objective To evaluate the surgical results of scoliosis associated with untreated syringomyelia with segmental pedicle screw system. Methods Thirty-five patients of scoliosis associated with untreated syringomyelia were treated with segmental pedicle screw system. Twelve cases were associated with type I Chiari malformation. The curve patterns covered atypical curve in 18 cases and atypical curve in 17 cases. There were two groups of operations: 1) Thirty cases, older than 10 years, underwent single-stage posterior correction, pedicle screw system internal fixation and bone-graft fusion; 2) Five cases, younger than 10 year, firstly underwent posterior correction and internal fixation with growth rod, and then posterior correction, internal fixation and bone-graft fusion 4-6 years later. Results The average coronal Cobb angle measured 66.5° (range, 32°-121°) preoperatively and 22.6° (range, 0°-78°) postoperatively. The average correction rate was 69.4% (range, 31%-100%). All the 35 cases were followed up 58.4 months in average (range, 13-113 months). The average coronal Cobb angle measured 25.9° (range, 3°-78°) at the latest follow-up. Six cases experienced deformity progressive after surgery. The caudal fusion vertebra was not fixed down to the stable vertebra in five of the six cases. It was shown absence of superficial abdominal reflex in one case, and expansion of sensory deficit in another one cases. Neither of two cases needed further management. Conclusion Segmental pedicle screw instrumentation is a safe procedure in treatment of scoliosis associated with untreated syringomyelia except Chiari malformation with distended type syringomyelia. Arthrodesis should be ended at the stable vertebra in the treatment of scoliosis associated with syringomyelia.