一期前后路平齐截骨矫正颈椎半椎体畸形

One- stage anteroposterior flat osteotomy for correction of cervical hemivertebra deformity

摘要:

[目的]介绍一期前后入路平齐截骨矫形法治疗先天性颈椎半椎体畸形的手术技术和初步临床效果。[方法]对 1 例先天性 C₆ 半椎体畸形采用上述手术治疗。该患者 C₆ 右侧半椎体且椎动脉穿过横突孔，术前行 3D 打印建立实体模型，设计截骨。先行前路手术，截除 C₆、C₇部分椎体，使 C₆、C₇下方获得平齐，无需处理 C₆右侧椎动脉；再行后路截骨及 C₅~T₁椎弓根螺钉固定；再次自前路行前侧钢板固定矫形。[结果]术程顺利，术中未出现脊髓神经及椎动脉损伤等并发症。手术时间为 5 h， 术中出血量约 400 ml。术后患者斜颈明显好转，颈椎 Cobb 角由术前 33°改善至术后的 5°。术后 X 线片及 CT 示颈椎冠状面平衡良好、内固定满意。[结论] 一期前后联合入路平齐截骨矫形法治疗先天性颈椎半椎体畸形效果满意，可避免截骨时处理椎动脉，提升手术安全性。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of one-stage anteroposterior flat osteotomy for correction of cervical hemivertebra deformity. [Methods] A 7-year girl received the abovesaid operation for congenital C₆ hemivertebra deformity, who had right hemivertebra of C₆ with vertebral artery passing through the transverse foramen. Before surgery a real cervical mod- el was made by 3D printing to design osteotomy. The anterior approach was conducted firstly to cut off part of the vertebral body of C₆ and C₇, so that the corresponding part of C₆ and C₇ was levelled without the need to deal with the right vertebral artery of C₆. The posterior approach was secondarily made to conduct posterior osteotomy of C₆, C₇, and had pedicle screw fixation of C₅~T₁. Finally, the anterior plate fixation was performed again through the anterior approach. [Results] The patient had operation performed successfully without complications such as spinal nerve and vertebral artery injury, while with operation time of 5 hours, and the intraoperative blood loss about 400 ml. The patient's torticollis improved significantly after surgery, with the Cobb angle of the cervical scoliosis improved from 33° before surgery to 5° after sur- gery and well cervical balance on the coronal plane on images and satisfactory placement of internal fixation implants. [Conclusion] This one-stage anteroposterior flat osteotomy achieves satisfactory preliminary clinical outcome for correction of cervical hemivertebra deformity, which does avoid interference of vertebral artery during osteotomy and improve the safety of the surgery.