实用骨科杂志
實用骨科雜誌
실용골과잡지
JOURNAL OF PRACTICAL ORTHOPEDICS
2014年
11期
965-968,969
,共5页
邹传奇%邱浩%张正丰%周跃%初同伟
鄒傳奇%邱浩%張正豐%週躍%初同偉
추전기%구호%장정봉%주약%초동위
先天性脊柱侧凸%脊柱后凸%半椎体切除%植骨融合%内固定
先天性脊柱側凸%脊柱後凸%半椎體切除%植骨融閤%內固定
선천성척주측철%척주후철%반추체절제%식골융합%내고정
congenital scoliosis%kyphosis%posterior hemivertebra resection%bone grafe fusion%internal fixation
目的：通过对本院经后路一期半椎体切除矫治先天性脊柱侧后凸畸形患者的分析，探讨术后近远期矫形效果。方法2008-2013年我院共对先天性脊柱半椎体畸形患者经后路半椎体切除植骨融合内固定术35例，男22例，女13例；年龄5~48岁，平均17.06岁。术前、术后即刻和随访时均拍摄脊柱正侧位 X 线片，并测量半椎体所致侧、后凸 Cobb 角等评估指标，分别计算它们的改善率，记录围手术期及远期并发症。结果手术时间1.75~5.83 h，平均3.68 h。术中出血量60~2000 mL，平均767.78 mL。全部病例随访13~60个月，平均35.8 个月。手术前、后及末次随访侧凸Cobb角分别为（44.41±18.49）°、（13.07±9.11）°、（15.54±8.94）°，术后即刻矫正率为（71.32±16.94）％，最终矫正率（64.35±19.53）％。手术前、后及末次随访后凸 Cobb 角分别为（34.58±26.18）°、（10.36±11.94）°、（11.94±11.81）°，术后即刻矫正率（67.91±21.89）％，最终矫正率（58.56±30.88）％。头侧出现新的后凸畸形1例，植骨不融合1例，通过二次手术，延长固定节段，畸形得到明显矫正。末次随访时均无椎弓根切割、神经系统并发症发生，无切口愈合不良、钉棒断裂及假关节形成等。结论对于先天性脊柱半椎体侧后凸畸形患者，采用一期经后路半椎体切除安全有效，具有手术时间短、出血量少、对脏器损伤小、并发症发生率低等优点。
目的：通過對本院經後路一期半椎體切除矯治先天性脊柱側後凸畸形患者的分析，探討術後近遠期矯形效果。方法2008-2013年我院共對先天性脊柱半椎體畸形患者經後路半椎體切除植骨融閤內固定術35例，男22例，女13例；年齡5~48歲，平均17.06歲。術前、術後即刻和隨訪時均拍攝脊柱正側位 X 線片，併測量半椎體所緻側、後凸 Cobb 角等評估指標，分彆計算它們的改善率，記錄圍手術期及遠期併髮癥。結果手術時間1.75~5.83 h，平均3.68 h。術中齣血量60~2000 mL，平均767.78 mL。全部病例隨訪13~60箇月，平均35.8 箇月。手術前、後及末次隨訪側凸Cobb角分彆為（44.41±18.49）°、（13.07±9.11）°、（15.54±8.94）°，術後即刻矯正率為（71.32±16.94）％，最終矯正率（64.35±19.53）％。手術前、後及末次隨訪後凸 Cobb 角分彆為（34.58±26.18）°、（10.36±11.94）°、（11.94±11.81）°，術後即刻矯正率（67.91±21.89）％，最終矯正率（58.56±30.88）％。頭側齣現新的後凸畸形1例，植骨不融閤1例，通過二次手術，延長固定節段，畸形得到明顯矯正。末次隨訪時均無椎弓根切割、神經繫統併髮癥髮生，無切口愈閤不良、釘棒斷裂及假關節形成等。結論對于先天性脊柱半椎體側後凸畸形患者，採用一期經後路半椎體切除安全有效，具有手術時間短、齣血量少、對髒器損傷小、併髮癥髮生率低等優點。
목적：통과대본원경후로일기반추체절제교치선천성척주측후철기형환자적분석，탐토술후근원기교형효과。방법2008-2013년아원공대선천성척주반추체기형환자경후로반추체절제식골융합내고정술35례，남22례，녀13례；년령5~48세，평균17.06세。술전、술후즉각화수방시균박섭척주정측위 X 선편，병측량반추체소치측、후철 Cobb 각등평고지표，분별계산타문적개선솔，기록위수술기급원기병발증。결과수술시간1.75~5.83 h，평균3.68 h。술중출혈량60~2000 mL，평균767.78 mL。전부병례수방13~60개월，평균35.8 개월。수술전、후급말차수방측철Cobb각분별위（44.41±18.49）°、（13.07±9.11）°、（15.54±8.94）°，술후즉각교정솔위（71.32±16.94）％，최종교정솔（64.35±19.53）％。수술전、후급말차수방후철 Cobb 각분별위（34.58±26.18）°、（10.36±11.94）°、（11.94±11.81）°，술후즉각교정솔（67.91±21.89）％，최종교정솔（58.56±30.88）％。두측출현신적후철기형1례，식골불융합1례，통과이차수술，연장고정절단，기형득도명현교정。말차수방시균무추궁근절할、신경계통병발증발생，무절구유합불량、정봉단렬급가관절형성등。결론대우선천성척주반추체측후철기형환자，채용일기경후로반추체절제안전유효，구유수술시간단、출혈량소、대장기손상소、병발증발생솔저등우점。
Objective To evaluate the outcomes of surgical treatment for congenital spinal deformity. Methods From 2008 to 2013,there were 35 consecutive cases with congenital scoliosis were managed surgically with one-stage posterior hemi-vertebra resection and segmental instrumentation fixation and fusion. There were 22 males and 13 females,with the average age of 17. 06 years(5 to 48 years). Long cassette standing radiographs were taken before and after surgery and at the final follow-up. Scoliosis,kyphosis and other indexes were measured preoperatively and immediatly postoperatively as well as at the latest follow-up. We calculated the improvement rate separately,and recorded the perioperative and long-term complications. Results The average operative time was 3. 68 hours with a mean 767. 78 mL of blood loss. The average follow-up was 26. 8 months ranging from 5 to 58 months. The scoliosis was(44. 41 ± 18. 49)° before surgery,(13. 07 ± 9. 11)° after surgery,and(15. 54 ± 8. 94)° at latest follow-up. The kyphosis was(34. 58 ± 26. 18)° before surgery and(10. 36 ± 11. 94)° after surgery and (11. 94 ± 11. 81)° at latest follow-up. Apical vertebral translation,cranial and caudal compensatory curve and other indexes were improved. There was new kyphosis in 1 case,bone graft unfusion in 1 case. In through the second operation,we extended the fixed section,dramatically corrected deformity. There were no major complications and no neurologic damage. Conclusion Posterior hemivertebra resection and internal fixation is a safe and reasonable surgical option for congenital and kyphosis de-formity.
