CAJ | 학술논문

目的探讨并总结青少年特发性颈椎后凸畸形的临床特征和分度、分期治疗策略的选择.方法回顾性分析2004年1月至2010年8月收治的115例青少年特发性颈椎后凸畸形患者.男34例,女81例;年龄12.4～18.4岁,平均15.1岁.先依治疗前的后凸Cobb角分度标准,将患者分为Ⅰ～Ⅳ度组:Ⅰ度组为12.7°±1.8°,共47例;Ⅱ度组为25.4°±6.4°,共31例;Ⅲ度组为47.2°±-4.1°,共22例;Ⅳ度组为62.6°±5.7°,共15例.对Ⅰ度组患者予以颈托保护下活动4～8周;对Ⅱ度组者予以颅骨牵引7～14d,达生理曲度后头颈胸石膏固定8～12周.以在伸展侧位片上测量的椎体后缘切线夹角作为依据,决定Ⅲ度组患者前路融合范围和Ⅳ度组后部截骨高度及角度;对Ⅳ度组患者采取分期治疗,先行后路截骨及前路松解术,术后行颅骨牵引7～10d、使颈椎后凸达到最大的矫正后,二期行颈前路矫形植骨内固定术.结果 Ⅰ度组患者佩戴颈托4～8周后X线片显示:Cobb角为-5.2°±3.1°;Ⅱ度组颅骨牵引后X线片显示:Cobb角为-8.2°±6.8°.术后3天X线片显示,Cobb角Ⅲ度组为-4.5°±7.2°,Ⅳ度组为-2.9°±7.9°.患者外观畸形明显矫正,颈痛及神经症状改善明显.Ⅲ度、Ⅳ度组患者治疗后颈椎MRI显示:颈椎生理曲度重建,后凸畸形区域脑脊液线清晰,脊髓未见压迫.结论对青少年特发性颈椎后凸畸形患者应进行全面评估,采取分度、分期治疗,形成合理的治疗策略.
목적 탐토병총결청소년특발성경추후철기형적림상특정화분도、분기치료책략적선택.방법 회고성분석2004년1월지2010년8월수치적115례청소년특발성경추후철기형환자.남34례,녀81례;년령12.4～18.4세,평균15.1세.선의치료전적후철Cobb각분도표준,장환자분위Ⅰ～Ⅳ도조:Ⅰ도조위12.7°±1.8°,공47례;Ⅱ도조위25.4°±6.4°,공31례;Ⅲ도조위47.2°±-4.1°,공22례;Ⅳ도조위62.6°±5.7°,공15례.대Ⅰ도조환자여이경탁보호하활동4～8주;대Ⅱ도조자여이로골견인7～14d,체생리곡도후두경흉석고고정8～12주.이재신전측위편상측량적추체후연절선협각작위의거,결정Ⅲ도조환자전로융합범위화Ⅳ도조후부절골고도급각도;대Ⅳ도조환자채취분기치료,선행후로절골급전로송해술,술후행로골견인7～10d、사경추후철체도최대적교정후,이기행경전로교형식골내고정술.결과 Ⅰ도조환자패대경탁4～8주후X선편현시:Cobb각위-5.2°±3.1°;Ⅱ도조로골견인후X선편현시:Cobb각위-8.2°±6.8°.술후3천X선편현시,Cobb각Ⅲ도조위-4.5°±7.2°,Ⅳ도조위-2.9°±7.9°.환자외관기형명현교정,경통급신경증상개선명현.Ⅲ도、Ⅳ도조환자치료후경추MRI현시:경추생리곡도중건,후철기형구역뇌척액선청석,척수미견압박.결론 대청소년특발성경추후철기형환자응진행전면평고,채취분도、분기치료,형성합리적치료책략.
Objective To explore the appropriate treatment according to the grading system of adolescent idiopathic cervical kyphosis.Methods A retrospective study was performed in 115 adolescent patients with idiopathic cervical kyphosis.The patients were divided into 4 groups according to the magnitude of kyphosis.The initial Cobb angle of 4 groups were 12.7°±1.4° 25.4°±4.8°,47.2°±4.4° and 62.6°±5.7° respectively.The patients in group I were treated with the collar support for 4-8 weeks.The patients in group Ⅱ were treated with skull traction (3-5 kg) and then fixed by cranio-cervical-thoracic plaster.According to the angles between the tangents of posterior vertebral body at each level on lateral cervical radiograph in extension,the anterior fusion levels of the group Ⅲ and angles and range of osteotomy in the group Ⅳ were decided.In group Ⅳ,the patients were treated by two steps.The anterior release and posterior osteotomy were performed firstly.Then skull traction (1/10 body weight) was maintained in order to correct the deformity for 7-10 days,fusion and anterior fusion with autologous bone graft and internal fixation was completed.Results Post-operative radiograph showed that Cobb angle were -5.5°±2.0°,-8.2°±6.1°,-4.5°±6.6° and -2.9°±7.9° in Ⅰ-Ⅳ group after treatment.The deformed appearance of the patients improved significantly.A improvement neck pain and neurologic function were found in all patients.Post-operative MRI showed that physiological curve of the cervical spine was restored,and the cerebrospinal fluid line was clear in the previous kyphosis area.Conclusion Adolescent idiopathic cervical kyphosis has specific characteristics.Surgical strategy is determined by the severity of deformity.