School of Medicine, University of California-Irvine, Medical Center, 101 The City Dr, Orange, CA 92868, USA.
Spine J. 2011 Mar;11(3):e5-11. doi: 10.1016/j.spinee.2011.01.020.
Myelomeningocele kyphosis is a complex disorder that usually requires surgical intervention. Many complications can occur as a result of this disorder and its treatment, but only surgical correction offers the possibility of restoring spinal alignment.
The purpose of this retrospective study was to summarize the surgical results, complications, and short-term and midterm outcomes for surgical correction of severe kyphosis using a consistent surgical technique.
This was a retrospective review of our database of pediatric patients with myelomeningocele and lumbar kyphosis who underwent kyphectomy with the use of the Warner and Fackler technique.
Eleven pediatric kyphectomy cases performed by a single surgeon from 1984 to 2009 were reviewed.
Outcome measures include imaging, kyphotic angle measurement, and physical examination.
Patients underwent the Warner and Fackler technique of posterior-only kyphectomy and bayonet-shaped anterior sacral fixation.
The mean extent of kyphosis was 115.6° (range, 77-176°) preoperatively with a correction to 13.0° (range, 0-32°) postoperatively, and a reduction with an average of 102.6° (range, 65-160°), for an 88.7% correction. On an average, 2.0 (range, 1-6) vertebrae were resected. Immediately postoperatively and at follow-up, with an average of 67.2 months (range, 8-222 months), the average kyphosis angle was 13.0° (range, 0-32°). All patients undergoing the procedure were unable to lie supine preoperatively. All patients postoperatively could lie in the supine position. The functional outcome in patients and caretakers was rated very favorably because all patients and caretakers who provided feedback (9 of 11) reported that they were satisfied with the procedure and would undergo the procedure again if given the choice.
This technique has become the most effective surgical reconstruction in myelomeningocele kyphosis. Although significant complications can occur during and after the procedure, most patients had satisfactory postoperative outcomes and restoration of sagittal balance with high patient and parent satisfaction.
脑脊膜膨出后脊柱后凸是一种复杂的疾病，通常需要手术干预。这种疾病及其治疗可能会产生许多并发症，但只有手术矫正才有恢复脊柱对线的可能。
本回顾性研究的目的是总结采用一致手术技术矫正重度脊柱后凸的手术结果、并发症以及短期和中期结果。
这是对我院数据库中 11 例接受脑脊膜膨出后路 Warner 和 Fackler 技术脊柱后凸切除术患儿的回顾性研究。
从 1984 年至 2009 年，单外科医生共完成 11 例小儿脊柱后凸切除术。
观察指标包括影像学、脊柱后凸角度测量和体格检查。
患者采用 Warner 和 Fackler 后路单纯脊柱后凸切除术联合枪刺状前路骶骨固定技术。
术前平均脊柱后凸角度为 115.6°（77°-176°），术后矫正至 13.0°（0°-32°），平均矫正 102.6°（65°-160°），矫正率为 88.7%。平均切除 2.0 个（1-6 个）节段。术后即刻及随访时（平均 67.2 个月，8-222 个月），平均脊柱后凸角度为 13.0°（0°-32°）。所有患者术前均无法仰卧位，术后均能仰卧位。患者和照顾者对功能结果的评价非常满意，因为所有提供反馈的患者和照顾者（11 例中的 9 例）均表示对手术过程满意，如果有选择，他们会再次接受手术。
该技术已成为脑脊膜膨出脊柱后凸最有效的手术重建方法。尽管手术过程中和手术后可能会出现严重并发症，但大多数患者术后结果满意，矢状面平衡得到恢复，患者和家长满意度高。
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