Mulpuri Kishore, LeBlanc Jacques G, Reilly Christopher W, Poskitt Kenneth J, Choit Rachel L, Sahajpal Vic, Tredwell Stephen J
Department of Orthopaedics, British Columbia's Children's Hospital, Vancouver, Canada.
Spine (Phila Pa 1976). 2005 Jun 1;30(11):E305-10. doi: 10.1097/01.brs.0000164267.30422.a9.
We present a descriptive case series outlining the surgical technique and outcome in six patients managed with a combined anterior neck and sternal splitting approach.
To describe a surgical approach used in the management of severe cervicothoracic kyphosis and/or scoliosis in pediatric patients.
There are few reports in the literature that address the problem of accessing multileveled spinal deformities around the cervicothoracic junction requiring stabilization in the pediatric population.
A detailed chart and radiographic review was completed of six consecutive patients managed at our center with a combined anterior neck and sternal splitting approach. The indications, surgical technique, and outcome are reviewed for each case. This technique was employed in 6 pediatric patients, aged 3-15 years, at the authors' institution. Diagnoses included Klippel-Feil Syndrome (2 patients), Proteus Syndrome, Larsen Syndrome, and neurofibromatosis type I (2 patients). All patients had severe cervicothoracic kyphosis requiring surgical instrumentation. This technique allowed surgical access from C5-T6.
This approach was invaluable in gaining access to the cervicothoracic junction to address complex spinal deformities in pediatric patients. In one patient, a separate thoracotomy was performed to access the lower thoracic spine. The only significant complication related to the approach was recurrent laryngeal nerve palsy experienced by one patient. This approach allowed stabilization of severe scoliotic and/or kyphotic deformities to impede curve progression.
This approach was invaluable in gaining multileveled access to the cervicothoracic junction to address complex spinal deformities in pediatric patients.
我们呈现了一个描述性病例系列，概述了采用颈部前方联合胸骨劈开入路治疗的6例患者的手术技术及结果。
描述一种用于治疗小儿严重颈胸段后凸和/或脊柱侧凸的手术入路。
文献中很少有报道涉及小儿人群中需要稳定化治疗的颈胸段交界处多级脊柱畸形的处理问题。
对在我们中心采用颈部前方联合胸骨劈开入路治疗的连续6例患者进行了详细的图表及影像学回顾。对每个病例的适应证、手术技术及结果进行了分析。该技术应用于作者所在机构的6例3至15岁的小儿患者。诊断包括Klippel-Feil综合征（2例）、变形综合征、Larsen综合征和I型神经纤维瘤病（2例）。所有患者均有严重颈胸段后凸需要手术内固定。该技术可实现从C5至T6的手术显露。
该入路对于显露颈胸段交界处以处理小儿复杂脊柱畸形非常有价值。1例患者需另行开胸手术以显露下胸段脊柱。与该入路相关的唯一显著并发症是1例患者出现喉返神经麻痹。该入路可稳定严重脊柱侧凸和/或后凸畸形以阻止畸形进展。
该入路对于多级显露颈胸段交界处以处理小儿复杂脊柱畸形非常有价值。
