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1、2010年4月,第8卷第2期JSpinalSurg,A,·67··臨床研究·經(jīng)后路全脊椎切除在重度脊柱側(cè)凸的臨床應(yīng)用解京明,王迎松,張穎,趙智,劉路平,楊振東【摘要】目的探討經(jīng)后路全脊椎切除術(shù)在矯治>100。的重度脊柱側(cè)凸時的臨床應(yīng)用特點(diǎn)及技術(shù)優(yōu)勢。方法回顧性分析2004年10月~2008年9月以全脊椎切除術(shù)聯(lián)合椎弓根釘棒治療的13例重度側(cè)凸患者,術(shù)前主彎Cobb角平均117.8。,冠狀面偏斜平均6.7cm;術(shù)中置人直徑為5.5~6.5mm椎弓根螺釘,通過全脊椎切除建立矯形空間后,直視下保護(hù)硬膜囊,獲得脊柱冠狀面整體平衡和側(cè)凸矯形。結(jié)果平均側(cè)凸矯形率為60.7%,冠狀面偏斜糾正82。
2、0%。術(shù)后1例發(fā)生脊髓缺血再灌注損傷,2周后恢復(fù),其余患者神經(jīng)功能Franke1分級同術(shù)前。術(shù)后6個月時,患者肺功能均較術(shù)前有所改善。平均隨訪22.5個月,矯形效果丟失<10%,1例內(nèi)固定棒斷裂。結(jié)論經(jīng)后路全脊椎切除聯(lián)合椎弓根釘棒器械矯形術(shù)可有效保護(hù)脊髓功能,獲得良好矯形效果,適用于重度脊柱側(cè)凸患者,特別是對伴有顯著通氣功能障礙的胸段側(cè)凸。【關(guān)鍵詞】脊柱側(cè)凸;截骨術(shù);脊柱融合術(shù);內(nèi)固定器【中圖分類號】R682.3【文獻(xiàn)標(biāo)志碼】A【文章編號】1672—2957(2010)02—0067—04Clinicalapplicationofposteriorvertebralcolumnres
3、ectioninseverescoliosisXIEJingming.WANGYingsong.ZHANGYing,ZHAOZhi,LIULuping,YANGZhendong.DepartmentofOrthopaedics,SecondAffiliatedHospitalofKunmingMedicalCollege,Kunming650101,China【Abstract】ObjectiveToevaluatetheclinicalapplicationfeaturesandexplorethetechniquepredominanceofposteriorvertebralc
4、olumnresectionincorrectingseverescoliosiswithmajorcurveover100。.MethodsThirteencasesofseoliosiswithmajorcurveover100。whichunderwentposteriorvertebralcolumnresectioncombinedwithpedicleinstrumentationtreat—mentfromOctober2004toSeptember2008werereviewed.PreoperativemeanCobb’Sanglewas117.8。anddiver
5、gencedis—tanceofspineoncoronalplatewas6.7em.Screwswithdiameterfrom5.5mmto6.5mmwerechosenandinsertedin,andthenvertebralcolumnresectionwasperformedinordertobuildthecorrectiongapthoughwhichtheduracanbeprotectedbyinsightanddeformitycorectionwithtrunkbalancebeaccomplished.ResultsTheaveragescoliosisc
6、orrectionratewas60.7%.a(chǎn)ndtrunkdeviationwas82.0%.Spinalcordischemicalreperfusioninjuryoccurredpostoperativelyin1caseandrecoveredtheaveragecorrectionrateof2weekslater.Fortherest,thereweren0iatrogenicneurologicaldefcitsobserved.Allthepatients’pulmonaryfunctionat6monthspostoperativewasimproved.Them
7、eanfollow-updurationwas22.5months.TheCobb’Sangleofseoliosisaftercorectionofdeformitywaslostlessthan10%.Internalfixatorrodbreakageoccuredin1case.ConclusionPosteriorvertebralcolumnresectioncombinedwithpedicleinstrumentationiseffecti