Herrera-Soto José A, Parikh Shital N, Al-Sayyad Mohamed J, Crawford Alvin H
Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
Spine (Phila Pa 1976). 2005 Oct 1;30(19):2176-81. doi: 10.1097/01.brs.0000180476.08010.c1.
Retrospective.
To determine whether anterior endoscopic release and posterior spinal fusion could achieve stable correction in Scheuermann's kyphosis.
The initial treatment of choice of Scheuermann's kyphosis is thoracic hyperextension and postural exercises and/or Milwaukee brace. Milwaukee bracing is most efficacious in the early stages when the curvature is flexible and in the skeletally immature. However, it is known that larger curves, vertebral wedging greater than 10 degrees, and skeletally mature patients will not usually respond to this treatment. Surgery is indicated in the skeletally immature with severe deformity where brace treatment has failed to prevent progression. Posterior spinal instrumentation can achieve adequate correction in the less rigid curves. However, the more rigid curves have been shown to be resistant to posterior spinal fusion alone, therefore needing anterior spinal release.
Between 1995 and 2001, 19 patients underwent video-assisted thoracoscopic surgery and posterior spinal fusion for the treatment of Scheuermann's kyphosis. The average age was 17.4 years with closed triradiate cartilage in all. Average follow-up was 2.7 years. An average of 8.3 discs were released anteriorly; an average of 13 levels were fused posteriorly.
Average preoperative kyphosis was 84.8 degrees. Average postoperative kyphosis was 43.7 degrees. Average kyphosis at follow-up was 45.3 degrees. Only 1.6 degrees of correction loss was noted. No junctional kyphosis was present. Two patients developed pleural effusion; one required thoracocentesis. Two patients developed pneumothorax. One patient underwent revision surgery for inferior hook pullout. One required mechanical ventilation.
Combined video-assisted thoracoscopic surgery release and posterior spinal fusion for the treatment of Scheuermann's kyphosis is a viable option for the treatment of the more severe and rigid curves.
回顾性研究。
确定前路内镜下松解联合后路脊柱融合术能否在休门氏后凸畸形中实现稳定的矫正。
休门氏后凸畸形的初始治疗选择是胸椎过伸和姿势锻炼及/或密尔沃基支具。密尔沃基支具在早期、侧弯柔软且骨骼未成熟时最为有效。然而，已知较大的侧弯、椎体楔形变大于10度以及骨骼成熟的患者通常对这种治疗无反应。对于骨骼未成熟且有严重畸形、支具治疗未能阻止病情进展的患者，需进行手术治疗。后路脊柱内固定可在较不僵硬的侧弯中实现充分矫正。然而，已证明较僵硬的侧弯仅靠后路脊柱融合难以矫正，因此需要前路脊柱松解。
1995年至2001年间，19例患者接受了电视辅助胸腔镜手术及后路脊柱融合术治疗休门氏后凸畸形。平均年龄17.4岁，所有患者的三骨骺软骨均闭合。平均随访2.7年。前路平均松解8.3个椎间盘；后路平均融合13个节段。
术前平均后凸角度为84.8度。术后平均后凸角度为43.7度。随访时平均后凸角度为45.3度。仅发现1.6度的矫正丢失。未出现交界性后凸畸形。2例患者出现胸腔积液；1例需要胸腔穿刺。2例患者出现气胸。1例患者因下钩拔出接受翻修手术。1例需要机械通气。
电视辅助胸腔镜手术松解联合后路脊柱融合术治疗休门氏后凸畸形是治疗更严重、更僵硬侧弯的可行选择。
