Akbar Michael, Bremer Ralph, Thomsen Marc, Carstens Claus, Abel Rainer
Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany.
Spine (Phila Pa 1976). 2006 Apr 20;31(9):1007-13. doi: 10.1097/01.brs.0000215018.14774.0f.
We retrospectively studied 24 consecutive pediatric patients with lumbar kyphosis due to myelodysplasia who had received corrective surgical treatment with the Warner and Fackler technique from 1994 to 2004.
The purpose of the study was to evaluate the technical problems and outcome and to identify complications of this treatment modality, especially regarding the biomechanics.
The management of lumbar kyphosis (8%-20%) in conjunction with myelodysplasia is difficult. In 1993, Warner and Fackler presented an elegant surgical technique, which was used here.
Corrective surgery was performed in 24 patients with an average preoperative lumbar kyphosis of 124 degrees . The correction was achieved by kyphectomy combined with stabilization using rods and wires as described by Warner and Fackler. Outcome was rated and complications were identified using data from the clinical records. For biomechanical analysis of the surgical construct, a force model was developed.
The mean extent of lumbar kyphosis could be corrected from 124 degrees before surgery to 43 degrees after surgery. Biomechanical analysis showed that inadequate correction results in implant failure.
Surgery should always be performed with the intention to reestablish the sagittal profile inasfar as possible so as to reduce the risk of implant failure.
我们回顾性研究了1994年至2004年间连续24例因脊髓发育不良导致腰椎后凸畸形并接受Warner和Fackler技术矫正手术治疗的儿科患者。
本研究的目的是评估技术问题和结果，并确定这种治疗方式的并发症，特别是在生物力学方面。
脊髓发育不良合并腰椎后凸畸形（8%-20%）的治疗很困难。1993年，Warner和Fackler提出了一种精妙的手术技术，本研究采用了该技术。
对24例术前平均腰椎后凸角度为124度的患者进行了矫正手术。按照Warner和Fackler的描述，通过椎体切除联合使用棒和钢丝进行固定来实现矫正。使用临床记录中的数据对结果进行评分并确定并发症。为了对手术结构进行生物力学分析，建立了一个力模型。
腰椎后凸的平均程度可从术前的124度矫正至术后的43度。生物力学分析表明，矫正不足会导致植入物失败。
手术应始终旨在尽可能重建矢状面轮廓，以降低植入物失败的风险。
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