Orthopedics and Traumatology, Sakarya University Faculty of Medicine, Sakarya 05400, Turkey.
Int Wound J. 2012 Jun;9(3):311-5. doi: 10.1111/j.1742-481X.2011.00885.x. Epub 2011 Nov 17.
This study is a case report of a meningomyelocele patient with congenital kyphosis who was treated with kyphectomy and a special approach to soft tissue healing. The objective of this study is to show a step by step approach to surgical treatment and postoperative care of a meningomyelocele patient with congenital kyphosis. In meningomyelocele the incidence of kyphosis is around 12-20%. It may cause recurrent skin ulcerations, impaired sitting balance and respiratory compromise. Kyphectomy has first been described by Sharrard. This surgery is prone to complications including pseudoarthrosis, skin healing problems, recurrence of deformity and deep infections. A 15-year-old male presented with congenital kyphosis due to meningomyelocele. He had back pain, deformity and bedsores at the apex of the deformity. The wound cultures showed Staphylococcus epidermidis colonisation at the apex. He was given appropriate antibiotic prophylaxis. During surgery, the apex of the deformity was exposed through a spindle-shaped incision. After instrumentation and excision of the apex, correction was carried out by cantilever technique. Two screws were inserted to the bodies of L3 and T11. After the operation, the skin was closed in a reverse cross fashion. He was sent to hyperbaric oxygen treatment for prevention of a subsequent skin infection and for rapid healing of skin flaps post operation. The patient's deformity was corrected from a preoperative Cobb angle of 135°-15° postoperative. The skin healed without any problems. Preoperative culture and appropriate antibiotic prophylaxis, spindle-shaped incision, reverse cross-skin closure and postoperative hyperbaric oxygen treatment can be useful adjuncts to treatment in congenital kyphosis patients with myelomeningocele to prevent postoperative wound healing and infection problems. Reduction screws and intracorporeal compression screws help to reduce the amount of screws and aid in corection of the deformity.
本研究是一例伴有先天性脊柱后凸的脑脊膜膨出患者的病例报告，该患者接受了脊柱后凸切除和特殊软组织愈合方法的治疗。本研究的目的是展示一例伴有先天性脊柱后凸的脑脊膜膨出患者的分步手术治疗和术后护理方法。在脑脊膜膨出中，脊柱后凸的发病率约为 12-20%。它可能导致皮肤溃疡反复发作、坐姿平衡受损和呼吸功能受损。脊柱后凸切除术最早由 Sharrard 描述。这种手术容易发生并发症，包括假关节形成、皮肤愈合问题、畸形复发和深部感染。一名 15 岁男性因脑脊膜膨出导致先天性脊柱后凸就诊。他有背部疼痛、畸形和畸形顶点处的褥疮。伤口培养显示，顶点处有表皮葡萄球菌定植。他接受了适当的抗生素预防。手术中，通过纺锤形切口暴露畸形顶点。在器械固定和切除顶点后，通过悬臂技术进行矫正。在 L3 和 T11 椎体插入两颗螺钉。手术后，皮肤以反向交叉方式关闭。他被送往高压氧治疗，以预防随后的皮肤感染和术后皮肤瓣的快速愈合。患者的畸形从术前 Cobb 角 135°-15°矫正为术后。皮肤愈合良好，无任何问题。术前培养和适当的抗生素预防、纺锤形切口、反向交叉皮肤闭合以及术后高压氧治疗，对于预防伴脑脊膜膨出的先天性脊柱后凸患者术后伤口愈合和感染问题，是一种有用的辅助治疗方法。复位螺钉和体内压缩螺钉有助于减少螺钉数量，并有助于矫正畸形。
