椎前分节不良脊柱后凸畸形的一期后路截骨矫正△

One-stage posterior osteotomy for the correction of congenital kyphosis due to anterior segmentation failure

摘要:

[目的] 介绍椎前分节不良脊柱后凸畸形一期后路截骨矫正的手术技术和初步临床效果。[方法] 2006 年—2017 年对单纯 WinterⅡ型先天性脊柱后凸患儿 13 例行一期经后路 Schwab 截骨联合内固定术。根据患儿年龄、后凸部位及病变范围确定截骨方式，其中 1 例采用 SPO (Smith-Petersen osteotomy, SPO) 截骨术，1 例同时采用 Ponte 及 VCRs 截骨术，5 例采用 PSO (pedicle subtraction osteotomy, PSO) 截骨术，4 例采用 BDBO (bone-disc-bone osteotomy, BDBO) 截骨术，1 例采用 VCR (verte- bral column resection, VCR) 截骨术，1 例采用 VCRs 截骨术。术后佩戴支具，维持矫正效果。[结果]13 例患儿均顺利完成手术，未出现严重并发症，术前合并神经系统症状者得到改善。平均随访(66.4±33.5)个月，术后及末次随访时主弯 Cobb 角较术前显著减小 (P＜0.05)，矢状位胸椎后凸角 (thoracic kyphosis, TK)、腰椎前凸角 (lumbar lordosis, LL) 均较术前显著改善 (P＜ 0.05)，骨盆角(T1-pelvic angle, TPA)较术前无明显变化(P＞0.05)。[结论] 椎前分节不良脊柱后凸畸形的一期后路截骨矫正是治疗单纯 WinterⅡ型先天性脊柱后凸的有效手术方式，且能控制畸形进展。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of the one-stage posterior osteotomy for the correction of congenital kyphosis due to anterior segmentation failure. [Methods] From 2006 to 2017, 13 children with pure Winter-II con- genital kyphosis underwent one-stage posterior Schwab osteotomies combined with internal fixation. The osteotomy mode was determined ac- cording to the age, kyphotic site and lesion range of the children. Smith-Petersen Osteotomy (SPO) in 1 case, Ponte osteotomy combined with VCRs in 1 case, pedicle subtraction osteotomy (PSO) in 5 cases, bone-disc-bone osteotomy (BDBO) in 4 cases, vertebral column resection (VCR) in 1 case, and VCRs in 1 case were performed correspondingly. Braces were worn after surgery to maintain the correction effect. [Re- sults] All the 13 children had corresponding surgical operations performed smoothly without serious complications. The patients who had neurological symptoms were improved after operation. At the latest follow-up lasted for (66.4±33.5) months the Cobb angle of the main curve significantly decreased (P＜0.05), and the thoracic kyphosis (TK), lumbar lordosis (LL) significantly improved (P＜0.05), whereas the T1-pel- vic angle (TPA) remained unchanged compared with those preoperatively (P＞0.05). [Conclusion] One-stage posterior osteotomy is an effec- tive surgical method for Winter type II congenital kyphosis with a benefit of controlling progression of the deformity.