中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
35期
5647-5653
,共7页
马华松%王晓平%谭荣%陈志明%陆明%袁伟%徐启明%任冬云%麻巍%李龙%张敬%郑蕊%辛莘
馬華鬆%王曉平%譚榮%陳誌明%陸明%袁偉%徐啟明%任鼕雲%痳巍%李龍%張敬%鄭蕊%辛莘
마화송%왕효평%담영%진지명%륙명%원위%서계명%임동운%마외%리룡%장경%정예%신신
植入物%脊柱植入物%僵硬性角状后凸%经后路全脊椎切除截骨%脊髓短缩技术%组织工程%生物力学
植入物%脊柱植入物%僵硬性角狀後凸%經後路全脊椎切除截骨%脊髓短縮技術%組織工程%生物力學
식입물%척주식입물%강경성각상후철%경후로전척추절제절골%척수단축기술%조직공정%생물역학
kyphosis%internal fixators%osteotomy%biomechanics
背景：严重脊柱角状后凸畸形可导致患者脊髓的损伤和早期退变等病理过程的加重，严重者会出现双下肢不完全瘫痪，甚至完全瘫痪。手术治疗是惟一的解决途径和方法，但难度大，风险高，并且极易出现术后并发症。目的：应用生物力学原理分析经后路全脊椎切除截骨联合阶梯矫形治疗僵硬性角状后凸的科学性和有效性。方法：选择严重脊柱角状后凸畸形经后路全脊椎切除截骨联合双侧钉棒梯次紧凑闭合脊髓逐步短缩、矫形内固定治疗的患者共90例，男37例，女52例，平均年龄47岁。对患者术前术后的后凸角、脊柱矢状位失平衡、躯干侧方偏移率、手术时间、术中失血量进行对比分析。结果与结论：患者术前后凸角为31°-138°，平均90.1°；术后10°-90°，平均41.6°，改善率为65%。C 7铅垂线距S 1后上缘距离术后平均5.2 mm，矫正率为73%。术中失血量为1200-6000 mL，平均失血量为2089 mL。手术时间为212-470 min，平均326 min。术后随访20-35个月，所有患者的截骨节段均获得骨性融合，无脊髓损伤并发症出现，无矫形角度丢失。提示根据细胞生物力学特点和脊柱生物力学原理设计的双侧钉棒联合阶梯紧凑闭合脊髓逐步短缩脊柱矫形治疗在胸腰椎角状后凸畸形的矫正过程中能够最大限度保护脊髓细胞不受损伤，具有充分的细胞生理学基础，符合人体生物力学和生理学特点。术中应注意对神经根的保护和松解，避免术后出现相对应的神经根刺激症状。充分的植骨融合是保证对后凸畸形矫正和避免脊柱侧方偏移，同时又是恢复脊柱功能和术后矫形效果的有效保障。
揹景：嚴重脊柱角狀後凸畸形可導緻患者脊髓的損傷和早期退變等病理過程的加重，嚴重者會齣現雙下肢不完全癱瘓，甚至完全癱瘓。手術治療是惟一的解決途徑和方法，但難度大，風險高，併且極易齣現術後併髮癥。目的：應用生物力學原理分析經後路全脊椎切除截骨聯閤階梯矯形治療僵硬性角狀後凸的科學性和有效性。方法：選擇嚴重脊柱角狀後凸畸形經後路全脊椎切除截骨聯閤雙側釘棒梯次緊湊閉閤脊髓逐步短縮、矯形內固定治療的患者共90例，男37例，女52例，平均年齡47歲。對患者術前術後的後凸角、脊柱矢狀位失平衡、軀榦側方偏移率、手術時間、術中失血量進行對比分析。結果與結論：患者術前後凸角為31°-138°，平均90.1°；術後10°-90°，平均41.6°，改善率為65%。C 7鉛垂線距S 1後上緣距離術後平均5.2 mm，矯正率為73%。術中失血量為1200-6000 mL，平均失血量為2089 mL。手術時間為212-470 min，平均326 min。術後隨訪20-35箇月，所有患者的截骨節段均穫得骨性融閤，無脊髓損傷併髮癥齣現，無矯形角度丟失。提示根據細胞生物力學特點和脊柱生物力學原理設計的雙側釘棒聯閤階梯緊湊閉閤脊髓逐步短縮脊柱矯形治療在胸腰椎角狀後凸畸形的矯正過程中能夠最大限度保護脊髓細胞不受損傷，具有充分的細胞生理學基礎，符閤人體生物力學和生理學特點。術中應註意對神經根的保護和鬆解，避免術後齣現相對應的神經根刺激癥狀。充分的植骨融閤是保證對後凸畸形矯正和避免脊柱側方偏移，同時又是恢複脊柱功能和術後矯形效果的有效保障。
배경：엄중척주각상후철기형가도치환자척수적손상화조기퇴변등병리과정적가중，엄중자회출현쌍하지불완전탄탄，심지완전탄탄。수술치료시유일적해결도경화방법，단난도대，풍험고，병차겁역출현술후병발증。목적：응용생물역학원리분석경후로전척추절제절골연합계제교형치료강경성각상후철적과학성화유효성。방법：선택엄중척주각상후철기형경후로전척추절제절골연합쌍측정봉제차긴주폐합척수축보단축、교형내고정치료적환자공90례，남37례，녀52례，평균년령47세。대환자술전술후적후철각、척주시상위실평형、구간측방편이솔、수술시간、술중실혈량진행대비분석。결과여결론：환자술전후철각위31°-138°，평균90.1°；술후10°-90°，평균41.6°，개선솔위65%。C 7연수선거S 1후상연거리술후평균5.2 mm，교정솔위73%。술중실혈량위1200-6000 mL，평균실혈량위2089 mL。수술시간위212-470 min，평균326 min。술후수방20-35개월，소유환자적절골절단균획득골성융합，무척수손상병발증출현，무교형각도주실。제시근거세포생물역학특점화척주생물역학원리설계적쌍측정봉연합계제긴주폐합척수축보단축척주교형치료재흉요추각상후철기형적교정과정중능구최대한도보호척수세포불수손상，구유충분적세포생이학기출，부합인체생물역학화생이학특점。술중응주의대신경근적보호화송해，피면술후출현상대응적신경근자격증상。충분적식골융합시보증대후철기형교정화피면척주측방편이，동시우시회복척주공능화술후교형효과적유효보장。
BACKGROUND:Severe spinal angular kyphosis aggravated spinal cord injury and early degeneration, even caused incomplete paralysis or complete paralysis. Surgical treatment is the only solving approaches and method, but it is difficult, exhibits high risk, and easily affects postoperative complications. OBJECTIVE:To analyze the science and effectiveness of posterior vertebral column resection osteotomy combined with step correction in treatment of stiff angular kyphosis based on biomechanical principle. METHODS:A total of 90 cases underwent posterior vertebral column resection osteotomy combined with bilateral pedicle screw spinal cord gradual y shortening echelon tight closure and orthopedic fixation were selected, including 37 males and 52 females, at the average age of 47 years. Kyphotic angle, spinal sagittal imbalance, trunk side offset rate, operation time, intraoperative blood loss were compared and analyzed before and after treatment. RESULTS AND CONCLUSION:The kyphotic angles were 31°-138° (averagely 90.1°) preoperatively and 10°-90° (averagely 41.6°) postoperatively, with an improvement rate of 65%. The distance from C 7 plumb line to the S 1 upper edge was averagely 5.2 mm, with a correction rate of 73%. Intraoperative blood loss was 1 200-6 000 mL, averagely 2 089 mL. Operation time was 212-470 minutes, averagely 326 minutes. The patients were fol owed up for 20 to 35 months after the surgery. Osteotomy segments had achieved bone fusion in al patients, and no complications of spinal cord injury or orthopedic angle loss appeared. These data verified that in the accordance with cellbiomechanics and spinal biomechanical principles, bilateral pedicle screw spinal cord gradual y shortening echelon tight closure and orthopedic fixation protected utmost spinal cord cells against injury in the correction of thoracolumbar angular kyphosis. There is sufficient basis for cellphysiology and it accorded biomechanical and physiological characteristics. During the surgery, we should pay attention to protection and release of nerve root and avoid postoperative corresponding nerve root irritation. Ful fusion ensures kyphosis correction and avoids spine lateral offset, is an effective safeguard for the recovery of spinal function and postoperative orthopedic effect.
