头盆环牵引全脊柱截骨内固定治疗重度脊柱弯曲.docVIP

　　头盆环牵引全脊柱截骨内固定治疗重度脊柱弯曲 【摘要】 ［目的］介绍头盆环牵引全脊柱截骨加内固定 治疗 重度脊柱弯曲的手术 方法 ，并 总结 185例重度脊柱弯曲的治疗结果。［方法］对重度脊柱侧弯患者，先用头盆环牵引，使重弯变为轻弯，以便置入器械的安装，再在头盆环牵引下进行截骨矫正畸形和内固定手术，术后继续配戴头盆环制动，术后第2 d即可下床站立活动，给护理工作带来极大方便。［结果］作者自1983～2003年，采用此法治疗重度脊柱侧弯185例，平均矫正率是70.32%。脊柱截骨断端能达到坚固的骨性融合，矫正率丢失平均在5°以内，术后晚期并发脱钩者4例，均经再次手术固定解决，对矫正效果无 影响 。1例术后1年并发感染，拆除置入器械后，伤口很快愈合，X线所见植骨愈合良好。1例并发神经根疼痛，而后逐渐减轻，所有病例未见脊髓损伤和神经系统并发症发生。［结论］头盆环牵引加全脊柱截骨是治疗重度脊柱侧弯的有效方法，对那些仅用单纯器械无法安装，置入困难的病例，经头盆环牵引后，内固定器械容易安装，再加上全脊柱截骨，能使弯曲的脊柱进一步伸直，减轻了内固定器械所承受的负荷力，避免了脱钩断棍的发生，为治疗重度脊柱侧弯的有效手段。 【关键词】 重度脊柱侧弯 头盆环牵引 全脊柱截骨术 　　Halo pelvic distraction in bination y and internal fixation for treatment of severe scoliosis 　　Abstract：［Objective］To report the records of 185 patients in severe scoliosis had been treated y and internal fixation.［Method］Preoperative halopelvic distraction ake the folloent possible. The n total spine osteotomy and internal fixation ed to rectify the remained deformity of the spine.Halopelvic distraction aintained during the operation and postoperatively to limit the mobilization of the patients.At one day after the operation,the patients ove around,making nursing care more convenient.［Result］Betoval of the inserted device.Xray examination confirmed good healing of the hone grafts.Root pain occurred in one case and the patient gradually recovered edical intervention.None of the rest patients had evidence of spinal cord or nervous system plications.［Conclusion］Halopelvic distraction instrumenation,in bination y,is an effective treatment modality for severe spinal curvatures.Halopelvic distraction can facilitate the operative procedure for those cases that can not be cured by application of single instrumentation or have difficulty in the insertion of the internal fixation device.The bined total spine osteotomy can further correct the spinal curves,reduce the burden of the fixafion device and avoid the occurrence of release or break doy 　　1 临床资料 　　作者自1983～2003年，手术治疗脊柱弯曲1 632例，其中头盆环牵引全脊柱截骨加器械矫正术185例，男55例，女130例;年龄5～35岁，平均13岁。先天性