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目的:探讨一期前后路联合入路半椎体切除、环形截骨矫形术治疗先天性颈椎侧凸畸形的可行性、安全性,评价其初步疗效。方法:2009年12月~2013年11月应用一期前后路联合入路半椎骨切除、环形截骨矫形术治疗13例颈椎半椎体畸形导致的先天性颈椎侧凸患者,回顾性分析患者的资料,观察临床效果。统计神经根、脊髓、椎动脉、硬膜囊损伤等严重并发症。对比分析术前和术后颈椎CT冠状面重建图像上颈椎侧凸结构曲线和颈椎或者上胸椎的代偿曲线(Cobb角)。结果:13例患者中男8例,女5例。年龄5~15岁(9.2±3.4岁)。11例接受一期前路截骨、后路截骨矫形内固定融合、前路内固定融合术;2例接受一期前路截骨、后路截骨矫形内固定融合术,术后Halo-vest支具固定3个月。手术时间210~520min(324±92min),出血量150~1000ml(585±319ml)。5例术后出现凸侧神经根刺激症状,4例在术后6个月时完全缓解,1例在术后24个月时肱三头肌肌力仍为3级。随访24~60个月(30.0±12.4个月),颈椎侧凸结构曲线Cobb角由术前9°~45°(28.3°±11.0°)矫正至0°~25°(6.9°±7.8°),矫正率为44.4%~100%[(78±24)%];颈椎或者上胸椎的代偿曲线Cobb角由术前0°~25°,(21.8°±5.8°)矫正至3°~23°(5.5°±4.3°),矫正率为8%~75%[(37±33)%]。末次随访时,患者头颈肩部外观显著改善。结论:采用一期前后路联合入路半椎体切除、环形截骨矫形术治疗先天性颈椎侧凸具有较好的可行性和安全性,初步临床及影像学效果满意。
Objective: To investigate the feasibility and safety of anterior and posterior approach combined with hemivertebra resection and circular osteotomy for the treatment of congenital cervical spondylosis. METHODS: From December 2009 to November 2013, 13 cases of congenital cervical spine scoliosis caused by cervical vertebral hemivertebra deformity were treated by anterior and posterior approach combined with semi-vertebral resection and ring osteotomy. Retrospective analysis of patients Data, observe the clinical effect. Statistical nerve root, spinal cord, vertebral artery, dural sac injury and other serious complications. The curve of cervical scoliosis curve and the compensatory curve (Cobb angle) of cervical vertebra or upper thoracic vertebrae were compared between preoperative and postoperative cervical spine CT images. Results: There were 8 males and 5 females in 13 cases. Aged 5 to 15 years (9.2 ± 3.4 years). 11 cases underwent anterior osteotomy, posterior osteotomy and internal fixation fusion, anterior fixation and fusion; 2 cases underwent anterior osteotomy and posterior osteotomy and orthopedic fixation, postoperative Halo- vest brace fixed for 3 months. The operative time was 210 ~ 520min (324 ± 92min) and the amount of bleeding was 150 ~ 1000ml (585 ± 319ml). In 5 cases, convex lateral nerve root irritation occurred. Four cases achieved complete remission at 6 months after operation. One case had a triceps muscle strength of 3 at 24 months after operation. During the follow-up of 24 to 60 months (30.0 ± 12.4 months), the Cobb angle of cervical scoliosis curve was corrected from 0 ° to 25 ° (6.9 ° ± 7.8 °) from 9 ° to 45 ° (28.3 ° ± 11.0 °) , The correction rate was 44.4% ~ 100% [(78 ± 24)%]; Cobb angle of compensatory curve of cervical or upper thoracic vertebra was corrected from 0 ° ~ 25 ° (21.8 ° ± 5.8 °) to 3 ° ~ 23 ° (5.5 ° ± 4.3 °), and the correction rate was 8% ~ 75% [(37 ± 33)%]. At the final follow-up, the appearance of the head, neck and shoulders was significantly improved. Conclusion: The anterior and posterior approach combined hemivertebra resection and ring osteotomy for the treatment of congenital cervical scoliosis has good feasibility and safety, and the preliminary clinical and imaging results are satisfactory.