棘突切除术改善脑脊膜膨出患者的坐姿和皮肤问题。
Kyphectomy improves sitting and skin problems in patients with myelomeningocele.
机构信息
Department of Orthopaedic Surgery, University of Colorado Denver Health Sciences Center, Denver, CO, USA.
出版信息
Clin Orthop Relat Res. 2011 May;469(5):1279-85. doi: 10.1007/s11999-010-1650-8.
BACKGROUND
Progressive kyphosis occurs in up to 20% of patients with myelomeningocele. Severely affected patients can develop recurrent skin breakdown, osteomyelitis, sitting imbalance, and poor cosmetic appearance.
QUESTIONS/PURPOSES: We (1) assessed the ability of kyphectomy to restore an intact skin envelope and allow comfortable seating in a wheelchair; (2) reviewed the complications of kyphectomy and spinal fusion in myelomeningocele; and (3) determined whether patients requiring unexpected reoperation had worse correction or more ulceration compared with those patients treated with a single surgery.
METHODS
We retrospectively reviewed the records of 23 children with thoracic-level myelomeningocele who were treated with kyphectomy and spinal fusion since 1980. Indications for surgery included recurrent skin breakdown (15 patients) and poor sitting balance or unacceptable cosmetic deformity (three patients). We evaluated operative technique, type of sacropelvic fixation, surgical complications, radiographic correction, and skin condition at followup. The minimum followup was 2 years (median, 4.1 years; range, 2.1-10 years); 18 of the 23 children had greater than 2 years followup and are reported here.
RESULTS
Kyphectomy achieved a sitting balance and resolved in skin ulceration in 17 of 18 patients. Seven patients had complications requiring reoperation. Three patients had multiple reoperations for early deep infection and one patient each had reoperation for late infection, pseudarthrosis, implant-related sacral pressure sore, and planned extension of proximal fusion after growth. Patients requiring multiple operations had similar correction and relief of ulceration to those treated with a single procedure.
CONCLUSIONS
Complications after kyphectomy are frequent and many children with myelomeningocele and severe hyperkyphosis require multiple procedures and lengthy hospital stays. Nonetheless, improved seating balance and resolution of skin problems was achieved in 17 of 18 patients.
背景
高达 20%的脊膜膨出患者会出现进行性后凸。严重受影响的患者可能会反复出现皮肤破裂、骨髓炎、坐姿失衡和外观不佳。
问题/目的：我们（1）评估了脊柱后凸切除术恢复完整皮肤包裹并允许在轮椅中舒适坐姿的能力；（2）回顾了脊膜膨出患者脊柱后凸切除术和脊柱融合术的并发症；（3）确定需要意外再次手术的患者与接受单次手术治疗的患者相比，矫正效果是否更差或溃疡更多。
方法
我们回顾性分析了自 1980 年以来接受脊柱后凸切除术和脊柱融合术治疗的 23 例胸段脊膜膨出患儿的病历。手术指征包括复发性皮肤破裂（15 例）和坐姿平衡差或不可接受的外观畸形（3 例）。我们评估了手术技术、骶髂固定类型、手术并发症、影像学矫正和随访时的皮肤状况。随访时间至少为 2 年（中位数为 4.1 年；范围，2.1-10 年）；23 例患儿中有 18 例随访时间大于 2 年，仅报告这 18 例患儿的情况。
结果
18 例患者中的 17 例通过脊柱后凸切除术获得了坐姿平衡并解决了皮肤溃疡问题。7 例患者发生并发症需要再次手术。3 例患者因早期深部感染多次手术，1 例患者因晚期感染、假关节形成、与植入物相关的骶骨压疮和生长后近端融合的计划延长而再次手术。需要多次手术的患者与接受单次手术的患者具有相似的矫正效果和溃疡缓解。
结论
脊柱后凸切除术的并发症很常见，许多患有脊膜膨出和严重脊柱后凸的儿童需要多次手术和长时间住院治疗。尽管如此，18 例患者中有 17 例获得了更好的坐姿平衡和解决了皮肤问题。
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