Odent Thierry, Arlet Vincent, Ouellet Jean, Bitan Fabien
Division of Orthopedic Surgery, McGill University, Shriners Hospital for Children, Montreal Children's Hospital, Quebec, Canada.
Eur Spine J. 2004 May;13(3):206-12. doi: 10.1007/s00586-003-0662-4. Epub 2004 Jan 9.
Rigid congenital kyphosis in myelomeningocele is associated with an important morbidity with skin breakdown, recurrent infection, and decreased function. Kyphectomy is the classic treatment to restore spinal alignment; however, surgery is associated with an important morbidity and long-term correction is uncertain. The authors retrospectively reviewed 9 patients with a mean age of 8.8 years who underwent a two stage surgical procedure: first a posterior kyphectomy with a modified Dunn-McCarthy fixation consisting of lumbar pedicle screws and long S-shape rods buttressing the anterior sacrum. Then a second stage done several weeks later consisting of a thoraco-abdominal approach to the spine with an inlay strut graft classically from T10-S1. The mean follow-up was 34 months (range 1-5 years). The kyphosis was corrected from a mean of 110 degrees of Cobb angle (range 70-130 degrees) to 15 degrees after surgery (45-0 degrees). There was no instrumentation failure, no loss of correction and no pseudarthrosis. Complications consisted of one intra-operative cardiac arrest fortunately reversible, a wound necrosis, one deep venous thrombosis and one late aseptic bursitis on the posterior hardware. Congenital kyphosis in myelomeningocele can be treated successfully with an initial posterior approach correction and instrumentation followed by an anterior approach allowing for anterior inlay impacted structural graft. The authors believe that this technique improves biomechanical and biological fusion mass anteriorly and will prevent late instrumentation failure and loss of correction.
脊髓脊膜膨出所致的僵硬性先天性脊柱后凸与皮肤破损、反复感染及功能减退等严重并发症相关。脊柱后凸切除术是恢复脊柱排列的经典治疗方法；然而，手术伴有严重并发症，且长期矫正效果尚不确定。作者回顾性分析了9例平均年龄8.8岁的患者，这些患者接受了两阶段手术：首先是后路脊柱后凸切除术，采用改良的邓恩 - 麦卡锡固定术，包括腰椎椎弓根螺钉和支撑前骶骨的长S形棒。几周后进行第二阶段手术，采用胸腹联合入路至脊柱，经典术式是从T10 - S1植入支撑性嵌体骨块。平均随访34个月（范围1 - 5年）。脊柱后凸由平均Cobb角110度（范围70 - 130度）术后矫正至15度（45 - 0度）。未出现内固定失败、矫正丢失及假关节形成。并发症包括1例术中心脏骤停（所幸可逆转）、1例伤口坏死、1例深静脉血栓形成以及1例后路内固定装置晚期无菌性滑囊炎。脊髓脊膜膨出所致先天性脊柱后凸可通过先行后路矫正及内固定，再行前路手术并植入前路支撑性结构性骨块得以成功治疗。作者认为，该技术可改善前方的生物力学及生物学融合块，预防晚期内固定失败及矫正丢失。
