一期后路楔形截骨治疗青春期后严重先天性脊柱侧弯.doc

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1、一期后路楔形截骨治疗青春期后严重先天性脊柱侧弯作者：郭海龙，盛伟斌，普拉提，詹玉林，金格勒，买尔旦【摘要】［目的］介绍一期后路楔形截骨治疗青春期后严重的先天性脊柱畸形的安全操作及探讨其融合固定范围的选择。［方法］自2000年2月〜2006年7月对16例青春期后严重的先天性脊柱侧弯采用一期后路楔形截骨内固定矫形。男10例，女6例;年龄16〜29岁，平均21.4岁。其中单纯半椎体11例，半椎体合并对侧骨桥或肋骨融合5例，既往有脊柱矫止手术史者2例。术前脊柱侧凸Cobb，s角64°〜108°,平均84.7°;脊柱后凸角28。~91°，平

2、均52.6°;躯干偏移3-23.6mm,平均15.4mm。CT或MRI显示椎管内骨性分隔2例。［结果］手术时间平均231min,术中出血平均1400ml。术后平均随访2年6个月。固定融合节段8〜14个椎体，平均10.6个。侧凸Cobb's角18。〜47。，平均38.5°，平均矫止率54.5%;后凸Cobb's角15。〜40°,平均27.7°,平均矫正率47.4%;术后躯干偏移0-11.4mm,平均为4・6耐。狈9、后凸和躯干偏移无明显矫正丢失。手术并发症包括术中椎弓根骨折2例;L1神经根损伤1例;肠系膜上动脉综合征1例；术后切口渗

3、液1例。［结论］采用一期后路楔形截骨内固定治疗青春期后严重的先天性脊柱侧弯是一个安全、可靠的方法，矫形效果满意，远期疗效可靠。【关键词】脊柱侧凸；脊柱后凸；楔形截骨；脊柱融合Abstract:[Objective]Tointroducethesafetyofthespinalwedgeosteotomybyasingleposteriorapproachandtodiscusstheseiectionoffusionandfixation・[Method]Sixteenpatientswithseverepost-adolesce

4、ntcongenitalspinaldeformitiesweretreatedbyspinalwedgeosteotomybyasingleposteriorapproachfromFebruary2000andJuly2006・Therewere10malesand6femaleswithanaverageageof21.4years(range16to29years)・Therewere11patientswithhemivertebreand5withfusedribsorbonebridge・Twopatientshad

5、previoussurgeryhistory.TheaverageCobb，sanglesofscoliosisandkyphosisbeforeoperationwere84.7°and52.6°・Theaveragetrunkshiftwas15.4inni.Bonyseptuminthecanalwasfoundin2patientsonthepreoperativeCTorMRT.[Result]Thefollow-uprangedfrom2to4yearswithanaverageof2yearsandsixmonths

6、・Theaveragefusedvertebraewere10.6segments(range8to14segments)・ThepostoperativeaverageCobb'sanglesofscoliosisandkyphosiswere38.5and27.7.Theaveragecorrectionratesofscoliosisandkyphosiswere54.5%and47.4%.Theaveragetrunkshiftwasimprovedto4.6mm.Therewasnosignificantcorrecti

7、onlossofthescoliosis,kyphosisandtrunkshiftatfinalexceptthattwohadpediclefracture,onehadLInerverootinjury,onehadsuperiormesentericarterysyndromeandonehadexudatesofincision.[Conclusion]Spinalwedgeosteotomybythesingleposteriorapproachisareliableandsafesurgicaltechniquefo

8、rcorrectingseverepost-adolescentcongenitalspinaldeformities.Keywords：scoliosis;kyphosis;wedgeosteotomy;spinalfusion半椎体或半椎体合并