摘要目的 针对严重脊柱角状后凸畸形设计一种新的矫形固定手术方式,观察手术的可行性、安全性和有效性.方法 2004年5月至2007年2月,采用后凸局部节段切除截骨,于断端撑开状态下双轴旋转矫形固定植骨融合技术治疗严重脊柱后凸畸形(平均Cobb角90.8°,范围50°～130°)16例.对所有患者进行手术前后的后凸局部和全脊柱正侧位X线摄片,测量后凸Cobb角,对7例合并侧凸的患者测量侧凸Cobb角.对手术前后和随访时的患者进行Frankel神经功能分级、Oswestry评分和术后PSI满意指数的评定,并观察术前存在腰背痛的患者术后的恢复情况.结果 16例患者手术时间平均为6.9 h,手术出血量平均为4000 ml.术中和术后并发症包括1例人工椎体松动,3例神经根损伤,3例硬膜撕裂,1例术后短期下肢功能障碍等,经妥善处理后均恢复良好.术后平均随访25个月.手术前脊柱后凸畸形平均为90.8°,术后即刻的平均后凸畸形为26.9°,平均矫正率为72.5%;随访时平均后凸畸形为28.9°,平均矫正率为70.1%,后凸畸形矫正无明显丢失.7例合并脊柱侧凸畸形的患者术前侧凸平均为35.9°,术后即刻的平均侧凸为4.4°,平均矫正率为87.2%;随访时平均侧凸畸形为6.1°,平均矫正率为78.6%,侧凸畸形矫正亦无明显丢失.部分患者神经功能较术前有所恢复,Frankel分级改善,术前共有E级5例,D级5例,C级5例,B级1例.随访时有E级10例、D级3例、C级3例.除外术前无症状的3例患者,术前患者平均Oswestry评分为18.9,术后平均Oswestry评分为10.8,平均改善率为52.7%.术后患者PSI满意指数显示完全满意10例,基本满意5例,总满意率为93.8%.术前共有3例患者存在明显的腰背痛,术后腰背痛完全缓解.结论 节段切除和截骨面撑开矫形固定植骨融合技术是治疗严重脊柱角状后凸畸形的有效方法 ,其畸形矫正率高,较为安全,中远期疗效良好.

abstractsObjective To design a new surgical correction and fixation technique for the treatment of severe angular kyphosis,observe the feasibility,safety and effectivity of the technique.Methods From May 2004 to Febuary 2007,16 cases with severe kyphosis(average 90.8°,range 50°-130°)were treated with segmental resection osteotomy,section distraction,dual axial rotation correction and instrumentational fusion technique.The patients were inspected by local and total spine anteroposterior and lateral radiography pre-and postoperatively.The kyphotic Cobb angle was measured and 7 cases combined scoliosis Cobb angle was also measured.The Frankel Grading for neurological function,Oswestry Disability Index(ODI)and Patients Satisfactory Index(PSI)were evaluated preoperatively,postoperatively and at follow-up.The back pain relief was also observed.Results The average surgical duration was 6.9 hours.The average blood loss was 4000 ml.The complications include 1 shifting of artificial vertebrae,3 nerve root injury,3 dural tear and 1 transitory dysfunction of lower extremity.All of these complications were relieved greatly after feasible treatment.The average follow-up time was 25 mouths.The average kyphotie angle was 90.8°preoperatively.which was improved to 26.9°immediately after surgery.and got an average correction rate of 72.5%.At follow-up,the average kyphotic angle was 28.9°,and correction rate was 70.1%.The 7 eases who combined with scoliosis had an average Cobb angle of 35.9°preoperatively,which decreased to 4.4°immediately after surgery,and the correction rate was 87.2%.The correction rate was kept until follow-up (78.6%).Some patients got an improved neurological function.The Frankel Grading were E in 5 cases,D in 5 cases,C in 5 cases,and B in 1 case preoperatively.There were 10 cases of E grade,3 cases of D grade,and 3 cases of C grade at follow-up.Except 3 cases who had no symptoms before surgery,the average ODI was 18.9 preoperatively,and 10.8 postoperatively.The average improvement of ODI Was 52.7%.The PSI result showed a satisfied rate of 93.8%.The back pain of 3 cases were totally relieved after surgery.Conclusions Segmental resection osteotomy with dual axial rotation correction and fusion technique is an effective way to treat severe angular kyphosis.It is a safe technique and has high correction rate.The longterm results is acceptable.