前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸_《華西醫學》

作者：

楊光輝 , 周春光 , 安永剛 , 宋躍明 , 劉浩 , 李濤 , 龔全 ,  劉立岷

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

脊柱側凸前路小切口頂椎切除后路矯形

DOI：

10.7507/1002-0179.20130311

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目的　探討前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸的可行性及療效。方法　2009 年7月－2010年9月，采用前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸18例。其中男9例，女9例，年齡10～24歲，平均14.5歲。其中15 例特發性脊柱側凸（Lenke 2型6例，Lenke 3型1例，Lenke 4型8例），2 例脊髓空洞合并脊柱側凸，1 例Chiari畸形合并脊柱側凸。術前剃刀背高度（6.8 ± 2.3）cm，主胸彎Cobb角（99.6 ±10.0）°，主胸彎頂椎偏距（7.3 ± 1.3）cm。結果　前路手術切口10～13 cm，平均（11.4 ± 1.0）cm；前路手術時間170～300 min，平均（215.3 ± 36.8）min；失血量300～1 300 mL，平均（662.5 ± 274.8） mL。所有患者隨訪25～39個月，平均30.7個月。末次隨訪時，剃刀背高度（1.0 ± 0.6）cm，矯正率86.7%；主胸彎Cobb角（31.4 ± 11.4）°，矯正率68.7%；主胸彎頂椎偏距（2.2 ± 0.9） cm，矯正率69.6%。上胸彎、胸腰彎/腰彎的Cobb 角及頂椎偏距亦明顯矯正，冠狀面及矢狀面平衡與術前相比，差異無統計學意義（P＞0.05）。未發生神經系統并發癥，1例患者在前路手術后入ICU行呼吸支持治療12 h，1例患者出現椎弓根螺釘穿透椎弓根上壁，2例患者出現鈦網位置不佳，隨訪未見鈦網位置改變。結論　采用前路小切口頂椎切除聯合后路矯形治療重度僵硬性脊柱側凸安全可行，矯形效果滿意。

引用本文： 楊光輝,周春光,安永剛,宋躍明,劉浩,李濤,龔全,劉立岷. 前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸. 華西醫學, 2013, 28(7): 1003-1007. doi: 10.7507/1002-0179.20130311 復制

1.	Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity[J]. Clin Orthop Relat Res, 2010, 468(3): 687-699.
2.	Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis[J]. The Lancet, 2008, 371(9623): 1527-1537.
3.	Harding IJ, Chopin D, Charosky S, et al. Long-term results of Schollner costoplasty in patients with idiopathic scoliosis[J]. Spine (Phila Pa 1976), 2005, 30(14): 1627-1631.
4.	Bradford D. Vertebral column resection[J]. Orthop Trans, 1987, 11(6): 502-510.
5.	Byrd JA, 3rd, Scoles PV, et al. Adult idiopathic scoliosis treated by anterior and posterior spinal fusion[J]. Bone Joint Surgery Ame Vol, 1987, 69(6): 843-850.
6.	Shufflebarger HL, Grimm JO, Bui V, et al. Anterior and posterior spinal fusion. Staged versus same-day surgery[J]. Spine (Phila Pa 1976), 1991, 16(8): 930-933.
7.	Li M, Ni J, Li Y, et al. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China[J]. J Paediatr Child Health, 2009, 45(5): 246-253.
8.	Kuklo TR, Lenke LG, O’brien MF, et al. Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees[J]. Spine (Phila Pa 1976), 2005, 30(2): 222-226.
9.	Suk SI, Kim JH, Cho KJ, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation?[J]. Eur Spine J, 2007, 16(9): 1359-1365.
10.	Luhmann SJ, Lenke LG, Kim YJ, et al. Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary?[J]. Spine (Phila Pa 1976), 2005, 30(18): 2061-2067.
11.	Dobbs MB, Lenke LG, Kim YJ, et al. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees[J]. Spine (Phila Pa 1976), 2006, 31(20): 2386-2391.
12.	O’brien MF, Lenke LG, Bridwell KH, et al. Preoperative spinal canal investigation in adolescent idiopathic scoliosis curves ＞ or = 70 degrees[J]. Spine (Phila Pa 1976), 1994, 19(14): 1606-1610.
13.	Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (＞100 degrees)[J]. Spine (Phila Pa 1976), 2008, 33(9): 979-983.
14.	Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis[J]. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
15.	Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation[J]. Spine (Phila Pa 1976), 1997, 22(14): 1590-1599.
16.	Lenke LG, O’leary PT, Bridwell KH, et al. Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients[J]. Spine (Phila Pa 1976), 2009, 34(20): 2213-2221.
17.	Tokunaga M, Minami S, Kitahara H, et al. Vertebral decancellation for severe scoliosis[J]. Spine (Phila Pa 1976), 2000, 25(4): 469-474.
18.	Bullmann V, Halm HF, Schulte T, et al. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis[J]. Eur Spine J, 2006, 15(4): 440-448.

1. 　Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity[J]. Clin Orthop Relat Res, 2010, 468(3): 687-699.
2. 　Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis[J]. The Lancet, 2008, 371(9623): 1527-1537.
3. 　Harding IJ, Chopin D, Charosky S, et al. Long-term results of Schollner costoplasty in patients with idiopathic scoliosis[J]. Spine (Phila Pa 1976), 2005, 30(14): 1627-1631.
4. 　Bradford D. Vertebral column resection[J]. Orthop Trans, 1987, 11(6): 502-510.
5. 　Byrd JA, 3rd, Scoles PV, et al. Adult idiopathic scoliosis treated by anterior and posterior spinal fusion[J]. Bone Joint Surgery Ame Vol, 1987, 69(6): 843-850.
6. 　Shufflebarger HL, Grimm JO, Bui V, et al. Anterior and posterior spinal fusion. Staged versus same-day surgery[J]. Spine (Phila Pa 1976), 1991, 16(8): 930-933.
7. 　Li M, Ni J, Li Y, et al. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China[J]. J Paediatr Child Health, 2009, 45(5): 246-253.
8. 　Kuklo TR, Lenke LG, O’brien MF, et al. Accuracy and efficacy of thoracic pedicle screws in curves more than 90 degrees[J]. Spine (Phila Pa 1976), 2005, 30(2): 222-226.
9. 　Suk SI, Kim JH, Cho KJ, et al. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation?[J]. Eur Spine J, 2007, 16(9): 1359-1365.
10. 　Luhmann SJ, Lenke LG, Kim YJ, et al. Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary?[J]. Spine (Phila Pa 1976), 2005, 30(18): 2061-2067.
11. 　Dobbs MB, Lenke LG, Kim YJ, et al. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees[J]. Spine (Phila Pa 1976), 2006, 31(20): 2386-2391.
12. 　O’brien MF, Lenke LG, Bridwell KH, et al. Preoperative spinal canal investigation in adolescent idiopathic scoliosis curves ＞ or = 70 degrees[J]. Spine (Phila Pa 1976), 1994, 19(14): 1606-1610.
13. 　Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (＞100 degrees)[J]. Spine (Phila Pa 1976), 2008, 33(9): 979-983.
14. 　Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis[J]. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
15. 　Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation[J]. Spine (Phila Pa 1976), 1997, 22(14): 1590-1599.
16. 　Lenke LG, O’leary PT, Bridwell KH, et al. Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients[J]. Spine (Phila Pa 1976), 2009, 34(20): 2213-2221.
17. 　Tokunaga M, Minami S, Kitahara H, et al. Vertebral decancellation for severe scoliosis[J]. Spine (Phila Pa 1976), 2000, 25(4): 469-474.
18. 　Bullmann V, Halm HF, Schulte T, et al. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis[J]. Eur Spine J, 2006, 15(4): 440-448.

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前路小切口頂椎切除聯合后路矯形手術治療重度僵硬性脊柱側凸

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