后路半椎体切除长节段固定矫治先天性脊柱畸形的临床疗效Clinical Efficacy of Posterior Hemivertebra Resection Combined with Long Segment Fixation for Treating Congenital Spinal Deformity
陈东;杨华;周林;潘家曌;
CHEN Dong;YANG Hua;ZHOU Lin;PAN Jiazhao;Guizhou Medical University;
摘要(Abstract):
目的:评价后路一期半椎体切除、三柱松解、椎弓根钉棒系统矫形治疗中重度先天性脊柱畸形的临床疗效。方法:28例半椎体畸形患者,采用后路半椎体切除、三柱松解、椎弓根钉棒系统矫形治疗,观察患者手术时间及手术中出血量,术后1周,1、3、6月,1年及2年随访,比较术前、术后各随访时点站立位全脊柱正侧位X线片、冠状面和矢状面Cobb角,观察并发症。结果:手术时间5~10 h,平均7.5 h;术中出血量300~2 100 mL,平均970 mL;术后1周及末次随访时侧凸和后凸Cobb角与术前比较均有明显改善,差异有统计学意义(P<0.05);所有病例均获得骨性融合,无严重并发症发生。结论:后路一期半椎体切除、三柱松解、椎弓根钉棒系统矫形治疗中重度先天性脊柱畸形安全有效。
Objective:To evaluate the surgical outcomes of posterior hemivertebra resection and three column relaxation with transpedicular instrumentation in the treatment of medium-to-severe rigidity congenital kyphoscoliosis caused by hemivertebra.Methods:28 consecutive cases of congenital scoliosis treated by posterior hemivertebra resection and three column relaxation with transpedicular instrumentation were investigated retrospectively.The clinical effects of surgical treatment for all patients were performed in the comparative analysis.Results:The average operation time was 7.5 hours(ranging 5.0~10.0 hours),the average blood loss in the operation was 970 mL(ranging 300~2 100 mL).All the patients got fusion at the final follow-up.There was no pseudarthrosis and instrument breakage,differences were statistically significant(P<0.05).Conclusions:Posterior hemivertebra resection,three column relaxation and internal fixation is a safe and reasonable surgical option for medium-to-severe rigidity congenital kyphoscoliosis,achieved reliable fusion and satisfactory effect.
关键词(KeyWords):
脊柱;脊柱侧凸;脊柱后凸;外科手术;半椎体切除;先天畸形;并发症
spine;scoliosis;kyphosis;surgical procedures;operative;hemivertebra resection;congenital deformity;complication
基金项目(Foundation):
作者(Author):
陈东;杨华;周林;潘家曌;
CHEN Dong;YANG Hua;ZHOU Lin;PAN Jiazhao;Guizhou Medical University;
Email:
DOI: 10.19367/j.cnki.1000-2707.2016.12.023
参考文献(References):
- [1]Mc Master MJ,Ohtsuka K.The natural history of congenital scolosis:a study of two hundred and fifty-one patients[J].J Bone Joint Surg(Am),1982(2):1128-1147.
- [2]李明,刘洋,朱晓东,等.一期前路松解后路三维矫形治疗重度,僵硬性脊柱侧凸[J].中华骨科杂志,2004(5):271-275.
- [3]Ruf MH.Hemivertebra resection by a posterior approach:innovative operative technique and firstreanhs[J].Spine,2002(10):1116-1123.
- [4]Mladenov K,Kunkel P,Stuecker R.Hemivertebra resection in children,results after single posterior approach and after combined anterior and posterior approach:a comparative study[J].Eur Spine,2012(3):506-513.
- [5]Callahan BC,Georgopoulos G,Eilerl RE.Hemivertebral excision for congenital scoliosis[J].J Pediar Orthop,1997(1):96-99.
- [6]王岩,张永刚,张雪松,等.后路半椎体切除、短节段经椎弓根内固定术治疗小儿先天性脊柱侧凸[J].中国脊柱脊髓杂志,2006(3):196-197.
- [7]Shono Y,Abumi K,Kaneda K.One-stage posterior hemivertebra resec-tion and correction using segmental instrumentation[J].Spine,2001(7):752-757.
- [8]仉建国,邱贵兴,刘勇,等.前后路一期半椎体切除术矫治脊柱侧凸[J]中华骨科杂志,2004(5):257-261.
- [9]Yaszay B,O'Brien M,Shufflebarger HL,et al.Efficacy of hemivert-ebra resection for congenital scoliosis:a multicenter retrospective comparison of three surgical techniques[J].Spine,2011(24):2052-2060.
- [10]郭建伟,仉建国,王升儒,等.后路半椎体切除治疗先天性脊柱侧凸的并发症及预防策略[J].中国骨与关节外科,2012(6):427-433.
- [11]李超,付青松,周宇,等.后路全脊椎切除与松解治疗先天性重度脊柱角状后凸[J].中华解剖与临床杂志,2014(4):268-274.
- [12]解京明,李韬,王迎松,等.大剂量氨甲环酸用于脊柱矫形手术的安全性和有效性[J].中国脊柱脊髓杂志,2016(1):48-54.
- [13]Cho SK,Yi JS,Park MS,et al.Hemostatic techniques reduce hospital stay following multilevel posterior cervical spine surgery[J].J Bone Joint Surg Am,2012(21):1952-1958.
- [14]Yeom JS,Buchowski JM,Shen HX,et al.Effect of fibrin sealant on drain output and duration of hospitalization after multilevel anterior cervical fusion:a retrospective matched pairanalysis[J].Spine,2008(16):543-547.
文章评论(Comment):
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- 脊柱
- 脊柱侧凸
- 脊柱后凸
- 外科手术
- 半椎体切除
- 先天畸形
- 并发症
spine - scoliosis
- kyphosis
- surgical procedures
- operative
- hemivertebra resection
- congenital deformity
- complication