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目的探讨顶椎楔形截骨术治疗重度僵硬型脊柱侧后凸畸形的临床疗效。方法 2012年5月—2014年10月，采用经后路顶椎楔形截骨术治疗的23例重度僵硬型脊柱侧后凸畸形患者，其中9例为特发性，14例为先天性，侧凸及后凸顶椎均位于同一节段。术前、术后及随访期间分别拍摄站立位脊柱全长正侧位X线片，测量侧凸及后凸Cobb角，评价矫形效果；采用SRS-22问卷评分评定日常生活能力。结果手术时间270~570 min，平均387 min；术中出血量900~2 700 mL，平均1 701 mL。所有患者随访> 24个月。侧凸Cobb角术前110.6°±23.4°，术后24个月41.4°±12.0°，矫正率为62.6%。后凸Cobb角术前91.5°±27.8°，术后24个月33.1°±14.7°，矫正率为63.8%。冠状面偏移术前（30.3±17.0） mm，术后24个月（19.6±15.1） mm；矢状面偏移术前（34.0±42.2） mm，术后24个月（10.3±15.9） mm。术后24个月SRS-22问卷各项得分及总分与术前相比均显著改善。所有患者术后12个月截骨部位均获得骨性融合。1例患者术后由于痰液阻塞出现肺不张，8例胸腔积液。1例发生神经系统并发症，术后3个月神经功能恢复至术前水平。结论顶椎楔形截骨术治疗重度僵硬型脊柱侧后凸畸形，矫形效果良好，能够实现冠状面和矢状面平衡的重建。 关键词： 胸椎腰椎脊柱侧凸脊柱后凸截骨术 Transpedicular wedge osteotomy of apical vertebrae for treatment of severe rigid kyphoscoliosis

Fulltext HUA Wen-bin YANG Cao* GAO Yong ZHANG Yu-kun WU Xing-huo LI Shuai WANG Kun YANG Shu-hua SHAO Zeng-wu Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China Fund Project: Abstract: Objective To evaluate the clinical outcomes of transpedicular wedge osteotomy of the apical vertebrae in patients with severe rigid kyphoscoliosis. Methods From May 2012 to October 2014, 23 patients with severe rigid kyphoscoliosis were treated by transpedicular wedge osteotomy of the apical vertebrae via posterior approach. Nine patients had a diagnosis of idiopathic kyphoscoliosis and the other 14 patients had a diagnosis of congenital kyphoscoliosis. The apical vertebrae of scoliosis and kyphosis were all in the same segment. Preoperative and postoperative scoliosis and kyphosis Cobb's angle were measured and compared. The SRS-22 questionnaire was used to evaluate the health-related quality of life. Results The operation time was 270-570 min with an average of 387 min, and the intraoperative blood loss was 900-2 700 mL with an average of 1 701 mL. All the patients were followed up for more than 24 months. The scoliosis Cobb's angle improved from preoperative 110.6°±23.4° to postoperative 24 months 41.4°±12.0°, with a correction rate of 62.6%. The kyphosis Cobb's angle was improved from preoperative 91.5°±27.8° to postoperative 24 months 33.1°±14.7°, with a correction rate of 63.8%. The coronal misregistration was improved from preoperative (30.3±17.0)mm to postoperative 24 months' (19.6±15.1)mm. The sagittal misregistration was improved from preoperative (34.0±42.2)mm to postoperative 24 months' (10.3±15.9)mm. Postoperative scores of SRS-22 questionnaire were all improved significantly compared with preoperative scores. Bony fusion of the osteotomy was achieved by postoperative 12 months. One case suffered from pulmonary atelectasis because of obstruction of thick sputum, and 8 cases suffered pleural effusion. Transient, unilateral leg paresis was observed in only 1 case, with recovery of neurological function at postoperative 3 months. Conclusion Transpedicular wedge osteotomy at the apical vertebrae is effective in the treatment of severe rigid kyphosis. It can achieve the reconstruction of coronal and sagittal balances. Keywords: Thoracic vertebrae Lumbar vertebrae Scoliosis Kyphosis Osteotomy