脊柱半椎体畸形术后疗效分析及手术适应征的探讨-第三军医大学学报.docVIP

PAGE 6 经后路一期半椎体切除手术时机的选择对矫形效果的影响 作者：邹传奇，邱浩 ，潘勇， 张超，周跃 通讯作者：初同伟 （第三军医大学新桥医院脊柱外科，400037） 摘要：目的：随访不同年龄经后路一期半椎体切除进行脊柱矫形患者，探讨如何把握手术时机才能达到满意的矫形效果。方法：2007年1月～2013年5月我院共收治经后路半椎体切除植骨融合内固定术36例，男22例，女14例；手术年龄在5-48岁之间，平均16.83岁。手术患者依据人类生长特点分为三组：A组小于等于10岁，B组10-20岁，C组大于等于20岁。术前、术后和随访时均拍摄脊柱正侧位 X 片；并测量脊柱侧、后凸cobb角等评估指标，分别计算改善率；分组比较手术时机对矫形效果的影响；记录围手术期及远期并发症。结果：全部病例随访 5～58个月，平均26.8个月。A、B、C组侧凸cobb角末次随访矫正率分别为66.71±22.55%，61.48±20.72%，74.43±10.08%；后凸cobb角末次随访矫正率分别为63.14±20.28%，50.86±34.24%，79.43±15.16%；C7PL-CSVL末次随访矫正率分别为81.64±12.14%，68.01±39.68%，80.66±11.04%。矫形效果A、C两组相当，B组稍差（P值？）。所有无伤口愈合不良、椎弓根切割、钉棒断裂等。末次随访时所有病例均未见假关节形成或其它并发症。结论：对于半椎体所致的先天性脊柱侧后凸畸形患者，采用经后路半椎体切除植骨融合内固定术是安全有效的；5-10岁之间为患者手术的最佳时期，在此年龄阶段越早进行手术，效果越好。 关键词：脊柱侧凸；脊柱后凸；后路半椎体切除；植骨融合内固定 The Options of Surgical Opportunity Affected Postoperation Clinical Effect in Posterior Hemivertebra Resection Congenital Spinal Deformity. Zou Chuan-qi，Chu Tong-wei，Zhou Yue，Zhang chao.Xinqiao Hospital，Third Military Medical University ，400037 [Abstract] Objective: To evaluate the outcomes of surgical treatment for congenital spinal deformity and study how to get satisfactory orthopedic effection through choosing surgical opportunity . Method: From January 2007 to January 2013，there were 36 consecutive cases with congenital scoliosis were managed surgically with one-stage posterior hemivertebra resection and segmental instrumentation fixation and fusion. 22 males and 14 females , with the average age at surgery was 16.83 years ranging from 5 to 48 years. There were three groups，Group A (≤ 10 years), group B(10-20 years), group C(≥ 20 years) .Long cassette standing radiographs were taken before and after surgery and at the final follow-up . Scoliosis, kyphosis and other indexes were measured preoperatively and immediatly postoperatively as well as at the latest follow-up . Calculated the improvement rate separately. Classification of age and comparision of orthopaedic effect. And record the perioperative and long-term complications. Result: The av