CAJ | 학술논문

目的：探讨后路一期小切口撑开联合二期全脊柱截骨术治疗极重度脊柱侧后凸的疗效和安全性。方法对26例行后路一期小切口撑开联合二期全脊柱截骨术的极重度脊柱侧后凸病例进行回顾性研究。其中男7例，女19例，年龄13～26岁，平均16.8岁。术前侧凸 Cobb’s 角98°～175°，平均135.33°；术前后凸 Cobb’s 角96°～170°，平均133.33°，后路矫形采用分期手术，一期采用小切口撑开矫形，使侧凸和后凸得到部分矫正。术后3～6个月再进行后路二期矫形，行后路截骨矫形内固定、剃刀背切除和植骨融合术，随访12～34个月，平均22个月。记录所有患者术前、一次术后、二次术前、二次术后和末次随访的影像学和临床资料以及围手术期并发症。结果所有病例均顺利完成手术，一期手术平均矫正侧凸61.43°(43.4%)，二次手术矫正25.49°(34.45%)。间隔期矫形丢失率3.13%，总矫形率61.8%，随访末次矫形平均丢失率2.92%，最终总矫形率58.83%。术前后凸 Cobb’s 角95°～175°，平均133.33°，一期手术矫正后平均后凸 Cobb’s 角79.67°，二次手术矫正后平均后凸 Cobb’s 角45°，末次随访平均后凸 Cobb’s 角47.26°。躯干和双肩的失平衡均得到显著改善。无严重脊髓、呼吸系统等并发症出现。结论对于极重度脊柱侧后凸采用后路分两期手术治疗，降低了手术难度，提高了二次手术耐受力；可以获得良好的畸形矫形效果，手术安全性得到提高。
목적：탐토후로일기소절구탱개연합이기전척주절골술치료겁중도척주측후철적료효화안전성。방법대26례행후로일기소절구탱개연합이기전척주절골술적겁중도척주측후철병례진행회고성연구。기중남7례，녀19례，년령13～26세，평균16.8세。술전측철 Cobb’s 각98°～175°，평균135.33°；술전후철 Cobb’s 각96°～170°，평균133.33°，후로교형채용분기수술，일기채용소절구탱개교형，사측철화후철득도부분교정。술후3～6개월재진행후로이기교형，행후로절골교형내고정、체도배절제화식골융합술，수방12～34개월，평균22개월。기록소유환자술전、일차술후、이차술전、이차술후화말차수방적영상학화림상자료이급위수술기병발증。결과소유병례균순리완성수술，일기수술평균교정측철61.43°(43.4%)，이차수술교정25.49°(34.45%)。간격기교형주실솔3.13%，총교형솔61.8%，수방말차교형평균주실솔2.92%，최종총교형솔58.83%。술전후철 Cobb’s 각95°～175°，평균133.33°，일기수술교정후평균후철 Cobb’s 각79.67°，이차수술교정후평균후철 Cobb’s 각45°，말차수방평균후철 Cobb’s 각47.26°。구간화쌍견적실평형균득도현저개선。무엄중척수、호흡계통등병발증출현。결론대우겁중도척주측후철채용후로분량기수술치료，강저료수술난도，제고료이차수술내수력；가이획득량호적기형교형효과，수술안전성득도제고。
Objective To explore the effectiveness and safety of surgical treatment of extremely severe scoliokyphosis by two stages of posterior distraction and total spinal osteotomy technique.Methods Twenty-six patients with extremely severe scoliokyphosis ( 9 males, 17 females ) were retrospective analyzed. The mean age was 16.8 years ( range: 13-26 years ). The mean preoperative Cobb’s angles were 135.33° ( range: 98°-175° ) for scoliosis and 133.33° ( 96°-170° ) for kyphosis. The surgical procedures were performed by two stages. The ifrst stage surgery was performed with posterior small incisions and distraction technique. Partial corrections of the scoliosis and kyphosis were achieve. The second stage surgery was performed 3-6 months after the ifrst stage surgery by posterior correction with total spinal osteotomy, shave abnormality excision and fusion. The mean follow-up period was 22 months ( range:12-34 months ). Radiographs and clinical data were recorded preoperatively, after the ifrst surgery, before the second surgery, after the second surgery and in the latest follow-up. Perioperative complications were noted.Results All surgeries went smoothly. The average curve magnitude was reduced 61.43° ( 43.4% ) after the ifrst stage surgery and reduced 25.49 ( 34.45% ) after the second stage surgery. The lost of correction between two surgeries was 3.13%. The total major coronal curve correction was 61.8%. Loss of correction averaged 2.92% for major coronal curve and the ifnal correction rate was averaged 58.83%. The average major sagittal curve magnitude was 133.33° ( range: 95°-175° ). The average total major sagittal curve was 79.69° after the ifrst stage surgery, 45° after the second stage surgery, and 47.26° in the latest follow up. Trunk and shoulder imbalance was signiifcantly improved. No severe complications in the spinal cord and respiratory system were noted.Conclusions Two-stage surgery is a safe and effective strategy for extremely severe kyphoscoliosis, which can improve the tolerance of patients to the second operation, reduce the risks and dififculties of the surgery and raise the correction rate and surgery safety.