中国综合临床
中國綜閤臨床
중국종합림상
Clinical Medicine of China
2015年
11期
1035-1038
,共4页
李勇%刘军%祁洁%段大鹏
李勇%劉軍%祁潔%段大鵬
리용%류군%기길%단대붕
脊髓纵裂%重度僵硬性先天性脊柱侧弯%后路脊椎截骨术
脊髓縱裂%重度僵硬性先天性脊柱側彎%後路脊椎截骨術
척수종렬%중도강경성선천성척주측만%후로척추절골술
Diastematomyelia%Severe and rigid congenital scoliosis%posterior spinal osteotomy
目的 探讨一期后路脊椎截骨术矫正重度僵硬性先天性脊柱侧弯合并Ⅰ、Ⅱ型脊髓纵裂的有效性和安全性.方法 52例患者根据脊髓纵裂分型分组,Ⅰ型组行骨性纵隔切除联合脊椎截骨术,Ⅱ型组不处理脊髓纵裂直接进行脊椎截骨.结果 本组平均手术时间(548.6±113.2) min,平均出血量(3 728.6±1 436.5) ml;其中Ⅰ型组平均手术时间(608.6±123.2) min,显著长于Ⅱ型组[(521.3±102.4)min,t=2.787,P＜0.0l],Ⅰ型组平均出血量(5 018.3±2 174.2) ml,显著多于Ⅱ型组[(2 615.3±1 132.8)ml,t=5.182,P＜0.01].患者术前测量Cobb角为(95.2±14.3)°,术后(35.2±14.8)°,随访2年(37.6±16.1)°;其中Ⅰ型组术前(92.3±12.8)°,术后(32.6±15.8)°,2年后(35.8±17.2)°;Ⅱ型组术前(99.2±17.3)°,术后(37.3±14.3)°,2年后(40.2±15.3)°,两组术后的Cobb角矫正率及矫正丢失率比较差异均无统计学意义(P均＞0.05),一期后路脊椎截骨术对于治疗Ⅰ型和Ⅱ型合并脊髓纵裂的重度僵硬先天性脊柱侧弯均有较好的矫正效果.本组患者并发症发生率21.2％(11/52);其中Ⅰ型组发生率36.4％(8/22),显著高于Ⅱ型组[10.0％ (3/30),P=0.021].结论 一期后路脊椎截骨术治疗合并脊髓纵裂的重度僵硬先天性脊柱侧弯具有可行性、有效性和安全性,Ⅰ型脊髓纵裂患者应先行骨性纵隔切除术,Ⅱ型脊髓纵裂则无需进行脊髓纵裂处理.
目的 探討一期後路脊椎截骨術矯正重度僵硬性先天性脊柱側彎閤併Ⅰ、Ⅱ型脊髓縱裂的有效性和安全性.方法 52例患者根據脊髓縱裂分型分組,Ⅰ型組行骨性縱隔切除聯閤脊椎截骨術,Ⅱ型組不處理脊髓縱裂直接進行脊椎截骨.結果 本組平均手術時間(548.6±113.2) min,平均齣血量(3 728.6±1 436.5) ml;其中Ⅰ型組平均手術時間(608.6±123.2) min,顯著長于Ⅱ型組[(521.3±102.4)min,t=2.787,P＜0.0l],Ⅰ型組平均齣血量(5 018.3±2 174.2) ml,顯著多于Ⅱ型組[(2 615.3±1 132.8)ml,t=5.182,P＜0.01].患者術前測量Cobb角為(95.2±14.3)°,術後(35.2±14.8)°,隨訪2年(37.6±16.1)°;其中Ⅰ型組術前(92.3±12.8)°,術後(32.6±15.8)°,2年後(35.8±17.2)°;Ⅱ型組術前(99.2±17.3)°,術後(37.3±14.3)°,2年後(40.2±15.3)°,兩組術後的Cobb角矯正率及矯正丟失率比較差異均無統計學意義(P均＞0.05),一期後路脊椎截骨術對于治療Ⅰ型和Ⅱ型閤併脊髓縱裂的重度僵硬先天性脊柱側彎均有較好的矯正效果.本組患者併髮癥髮生率21.2％(11/52);其中Ⅰ型組髮生率36.4％(8/22),顯著高于Ⅱ型組[10.0％ (3/30),P=0.021].結論 一期後路脊椎截骨術治療閤併脊髓縱裂的重度僵硬先天性脊柱側彎具有可行性、有效性和安全性,Ⅰ型脊髓縱裂患者應先行骨性縱隔切除術,Ⅱ型脊髓縱裂則無需進行脊髓縱裂處理.
목적 탐토일기후로척추절골술교정중도강경성선천성척주측만합병Ⅰ、Ⅱ형척수종렬적유효성화안전성.방법 52례환자근거척수종렬분형분조,Ⅰ형조행골성종격절제연합척추절골술,Ⅱ형조불처리척수종렬직접진행척추절골.결과 본조평균수술시간(548.6±113.2) min,평균출혈량(3 728.6±1 436.5) ml;기중Ⅰ형조평균수술시간(608.6±123.2) min,현저장우Ⅱ형조[(521.3±102.4)min,t=2.787,P＜0.0l],Ⅰ형조평균출혈량(5 018.3±2 174.2) ml,현저다우Ⅱ형조[(2 615.3±1 132.8)ml,t=5.182,P＜0.01].환자술전측량Cobb각위(95.2±14.3)°,술후(35.2±14.8)°,수방2년(37.6±16.1)°;기중Ⅰ형조술전(92.3±12.8)°,술후(32.6±15.8)°,2년후(35.8±17.2)°;Ⅱ형조술전(99.2±17.3)°,술후(37.3±14.3)°,2년후(40.2±15.3)°,량조술후적Cobb각교정솔급교정주실솔비교차이균무통계학의의(P균＞0.05),일기후로척추절골술대우치료Ⅰ형화Ⅱ형합병척수종렬적중도강경선천성척주측만균유교호적교정효과.본조환자병발증발생솔21.2％(11/52);기중Ⅰ형조발생솔36.4％(8/22),현저고우Ⅱ형조[10.0％ (3/30),P=0.021].결론 일기후로척추절골술치료합병척수종렬적중도강경선천성척주측만구유가행성、유효성화안전성,Ⅰ형척수종렬환자응선행골성종격절제술,Ⅱ형척수종렬칙무수진행척수종렬처리.
Objective To evaluate the effectiveness and safety of one stage posterior vertebral osteotomy for correction of severe and rigid congenital scoliosis associated with Ⅰ, Ⅱ type of diastematomyelia.Methods According to the diastematomyelia packet,52 patients were divided into type Ⅰ group performed with mediastinum resection combined with spinal osteotomy, group Ⅱ without treatment of diastematomyelia direct spinal osteotomy.Group Ⅲ spinal osteotomy directly without diastematomyelia.Results The mean operation time was (548.6±113.2) min,the average amount of bleeding was (3 728.6±1 436.5) ml.In group Ⅰ,the mean operation time was (608.6± 123.2) min, significantly longer than those of group Ⅱ ((521.3 ±102.4) min,t=2.787,P＜0.01).In group Ⅰ the average amount of bleeding was (5 018.3 ±2 174.2) ml, significant more than that of group Ⅱ((2 615.3± 1 132.8) ml,t=5.182,P＜0.01).Patients with preoperative Cobb angle measurement for (95.2± 14.3) degrees, postoperative for (35.2± 14.8) degrees, follow-up of 2 years for (37.6± 16.1) degrees, group Ⅰ included preoperative (92.3 ± 12.8) degrees, postoperative (32.6 ± 15.8)degrees, 2 years later (35.8 ± 17.2) degrees;group Ⅱ before operation (99.2 ± 17.3) degrees, postoperative (37.3±14.3)degrees, 2 years later (40.2± 15.3) degrees.The postoperative Cobb angle correction rate and correction loss rate showed no significant difference between two groups (P ＞0.05), a posterior spinal osteotomy for the treatment of type Ⅰ and type Ⅱ with diastematomyelia severe rigid congenital scoliosis has good correction effect.This group of patients, the complication rate was 21.2％ (11/52);where in Ⅰ group the incidence rate of 36.4％ (8/22) was significantly higher than that of Ⅱ group 10.0％ (3/30) (P =0.021).Conclusion One stage posterior vertebral osteotomy for severe rigid with diastematomyelia of congenital scoliosis with the feasibility, effectiveness and safety, patients with type Ⅰ diastematomyelia should first bony mediastinum resection, Ⅱ type of diastematomyelia there is no need for treatment of diastematomyelia.
