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[目的]探讨儿童先天性腰骶椎后凸合并脊髓畸形一期脊髓圆锥松解、后路顶椎切除椎弓根钉腰骨盆内固定治疗的可行性及临床疗效。[方法]手术步骤包括椎弓根钉固定腰椎、骶椎或髂骨翼,松解圆锥,后路切除顶椎,加压矫正后凸并自体骨加异体骨植骨融合。[结果]5例患儿后凸及神经症状逐渐加重。全部病例合并脊髓纵裂脊髓空洞脊髓低位栓系,固定1～3个腰椎节段。术前后凸Cobb角52°～91°,平均76°,术后Cobb角后凸15°～30°,平均22°,校正率63%～80%,平均71%。手术时间225～390分,平均300min,出血300～600ml,平均420ml。随访时间24～52个月,平均32个月。1例术后短暂神经症状加重,随访时5例神经症状均较术前好转,3例恢复明显。[结论]一期脊髓圆锥松解后路顶椎切除椎弓根钉腰骨盆内固定治疗先天性腰骶椎后凸合并脊髓畸形短期随访疗效好,手术可导致神经症状短暂加重。治疗越早效果越好,并发症越少。
[Objective] To explore the feasibility and clinical efficacy of primary condylar lumbar sacral kyphosis with spinal deformity in primary spinal conization and posterior apical vertebrectomy in pedicle screw fixation. [Methods] Surgical procedures included pedicle screw fixation of lumbar spine, sacral or iliac wing, release of cone, posterior apical debridement, correction of posterior bulging and autologous bone allograft fusion. [Results] The kyphosis and neurological symptoms of 5 cases were gradually aggravated. All patients with spinal cord lobar spinal cord lobe spinal cord tied low, fixed 1 to 3 lumbar segments. The Cobb angle before and after operation was 52 ° ~ 91 ° with an average of 76 °. Cobb angle was 15 ° ~ 30 ° with an average of 22 °. The correction rate was 63% -80% with an average of 71%. The operation time was 225-390 minutes, with an average of 300 minutes. The hemorrhage was 300-600ml with an average of 420ml. Follow-up time of 24 to 52 months, an average of 32 months. One patient had transient neurological symptoms worsened. All the 5 neurological symptoms at the follow-up were better than those before operation, and 3 patients recovered obviously. [Conclusion] The short-term follow-up of congenital lumbosacral kyphosis combined with spinal deformity after primary apical debridement and pedicle screw fixation of lumbar pelvis undergoing primary conization of the spinal cord is effective. The surgery may cause a brief increase of neurological symptoms. The sooner the treatment is, the better the complication is.