全脊柱截骨矫正严重后凸畸形
全脊柱截骨矫正严重后凸畸形
作者:
马原，黄卫民，李磊，郑君涛
【关键词】 全脊柱截骨 摘要:
,目的,探讨全脊柱截骨矫正脊柱后凸的治疗经验。,方法,全脊柱截骨加椎弓根钉内固定系统闭合及植骨矫正脊柱后凸。,结果,于1984~2017年采用上述方法治疗50例病人。术后全组病例均未发生脊髓损伤，术后临床症状得到不同程度的改善。经历2~15 a平均24 a随访,X线CT复查示螺钉位置良好，无松动断钉。植骨3个月后均达到满意融合。,结论,经全脊柱截骨加有效的内固定手术不仅手术视野开阔操作安全方便;而且截骨和内固定相结
合同
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时完成,是治疗脊柱后凸目前更完善并不断改进一种好方法。
关键词:
全脊柱截骨;后凸;矫形手术 Correction of severe kyphosis and kyphoscoliosis by total spinal osteotomy Abstract:
,Objective,To explore the experience of the correction of severe kyphosis and kyphoscoliosis by total spinal osteotomy,Method,To correct kyphosis and kyphoscoliosis by total spinal osteotomy and screwsrods internal fixation apparatus,then graft the bone,Result,From 1984 to 2017,50 patients were cured with the way
neural injury observedThe clinical symptom was improved aboveThere were no
in some extentAll patients were follow up from 2 months to 15 years,averaged 24 years,and the postoperative X ray and CT scans verifies all screws were in a proper positionNo cases of implant failure were observed,and all the patients had a solid bone fusion on radiographs taken 3 months after surgery,Conclusion,The operation to correct severe kyphosis and kyphoscoliosis by total spinal osteotomy with efficient screwsrods internal fixation apparatus,not only have a larger operate area which made opreation easier and more safe,but bine osteotomy with internal fixation and finished at the same time,it is an efficient way to correct kyphosis and kyphoscoliosis Key words:
Total spinal osteotomy;Kyphosis;Corrective surgery 1984~2017年，采用全脊柱截骨加椎弓根钉内固定系统闭合及植骨的方法治疗脊柱后凸50例，疗效满意，介绍如下。
1临床资料 11一般资料 本组共50例，男36例，女14例;年龄17~57岁，平均296岁。病程3~30 a。
111临床表现 1111症状 本组50例患者中36例疲劳感及疼痛症状，10例有下肢麻木感，2例有截瘫症状。
1112体征 脊柱活动度均有一定丧失，均进行脊柱外科专科查体。2例胸腰段活动完全消失。有32例感觉异常，15例反射异常。有5例为重度脊柱后凸，运动功能感觉功能及扩约肌功能失调。
112影像学检查 常规以后凸顶点为中心正侧位及左右旋转位、过伸过屈位X线摄片及CT、MRI。以明确后凸的部位、角度及了解是否有前纵韧带骨化及腹主动脉硬化阴影。发现有5例为重度脊柱后凸，Cobbs角最大160?，最小60?，平均926?。有3例为半椎体形成，2例为分节不良。
12手术治疗 121手术方法 1211切口后凸顶点为中心纵形切口。
1212椎弓跟截骨术后凸顶点的椎板间有骨性融合者应直接截骨术,无融合者应切除后凸顶点拟截骨椎体的一节椎弓。暴露硬膜管和双侧椎弓根。检查有无脊髓纵裂。自椎弓根外纵平面截断和切除横突。沿椎弓根的外侧缘用椎体剥离器自骨膜下向前剥离至椎体的外侧缘推开骨膜和前纵韧带，放入撬板暴露椎体侧面，为下一步截骨做好准备。
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