Department of Orthopedics, CPLA 306 Hospital, 9 North Anxiang Road, Beijing 100101, China.
Arch Orthop Trauma Surg. 2012 Feb;132(2):193-201. doi: 10.1007/s00402-011-1415-1. Epub 2011 Nov 8.
To review the outcomes of surgical treatment for severe spinal deformities via a two-stage posterior-only approach.
A total of 18 patients with large and rigid spinal deformities were studied based on clinical and radiographic data. All of them received a two-stage posterior-only approach: first on the concave side by internal distraction of pedicle screws and rods through intramuscular tunnels, followed by respiratory function exercise and improving nutritional status during the intervening period, and finally by posterior additional correction, ultimate instrumentation and spinal fusion in the second operation.
The mean major coronal curve was corrected by 46% after the first operation and by 60.4% after the second operation. The mean thoracic kyphosis was corrected by 50.9% after the first operation and by 64.8% after the second operation. The loss of correction mean was 3.3° for the major coronal curve and 2.6° for the thoracic kyphosis at a mean of 31.5 months follow-up. The mean operation time for the first and second operation was 186.2 and 300.6 min, and the mean intraoperative blood loss was 211.1 and 1,597.2 mL, respectively. No severe complication was noticed in this series.
The two-stage posterior-only procedures permitting stepwise correction for the treatment of severe spinal deformities provide safe and satisfactory outcomes in this patient population.
回顾经两阶段后路手术治疗重度脊柱畸形的结果。
根据临床和影像学资料，研究了 18 例大且僵硬的脊柱畸形患者。所有患者均采用两阶段后路方法治疗：首先在凹侧通过经肌隧道内的椎弓根螺钉和棒进行内部牵张，在此期间进行呼吸功能锻炼和改善营养状况，然后在第二期手术中进行后路附加矫正、最终器械和脊柱融合。
第一次手术后，主要冠状曲线平均矫正 46%，第二次手术后平均矫正 60.4%。第一次手术后，平均胸曲平均矫正 50.9%，第二次手术后平均矫正 64.8%。主要冠状曲线的平均矫正丢失为 3.3°，胸曲的平均矫正丢失为 2.6°，随访平均为 31.5 个月。第一次和第二次手术的平均手术时间分别为 186.2 和 300.6 分钟，术中平均出血量分别为 211.1 和 1597.2 毫升。本系列中未发现严重并发症。
两阶段后路分步矫正重度脊柱畸形的手术方法为该患者人群提供了安全且满意的结果。
