Melloh Markus, Hodgson Bruce, Carstens Alan, Cornwall Jon
Western Australian Institute for Medical Research (WAIMR), University of Western Australia, Nedlands, Western Australia, Australia.
Department of Orthopaedic Surgery, Dunedin Public Hospital, Dunedin, New Zealand.
Evid Based Spine Care J. 2013 Apr;4(1):59-62. doi: 10.1055/s-0033-1341599.
Study Design Case report. Objective The aim of this study is to describe a case of vascularized fibula strut graft implanted in the cervicothoracic spine of a patient with neurofibromatosis type 1-related progressive kyphosis. Methods A detailed history examination of the surgical procedures and the results of the follow-up after fibula strut graft implantation were performed. In addition, a review of the literature was conducted to access the incidence of similar cases with an almost complete reversal of a deformity-induced tetraparesis. Results A 37-year-old man with severe type 1 neurofibromatosis causing a collapsing kyphosis of the cervicothoracic spine presented in 2006 with progressive low cervical tetraparesis. Intervention included posterior stabilization (C5 to T5) which was extended to C3-T9 in 2008; however, the kyphosis continued to worsen. In 2009, a vascularized fibula strut graft was implanted between the inferior and superior endplates of C3 and T9. Over the following months, the patient gradually recovered motor strength and improved functional use of all limbs. In March 2011, lower limb (bilateral) and right arm strength was grade 5, with left arm strength being grade 4+. Conclusions This case report demonstrates the existence of a potential local option for the difficult problems of pseudoarthrosis, progressive spinal deformity, and cord compromise in patients with neurofibromatosis type 1-related kyphosis resulting in an almost complete reversal of deformity-induced tetraparesis.
研究设计 病例报告。目的 本研究旨在描述1例血管化腓骨支撑植骨术应用于1型神经纤维瘤病相关进行性脊柱后凸患者的颈胸段脊柱的病例。方法 对手术过程进行详细的病史检查，并对腓骨支撑植骨术后的随访结果进行分析。此外，还对文献进行了回顾，以了解畸形导致的四肢瘫痪几乎完全逆转的类似病例的发生率。结果 一名37岁男性，患有严重严重严重性1型神经纤维瘤病，导致颈胸段脊柱严重后凸，于2006年出现进行性低位颈髓性四肢瘫痪。干预措施包括后路稳定术（C5至T5），2008年扩展至C3-T9；然而，后凸仍继续加重。2009年，在C3和T9的上下终板之间植入了血管化腓骨支撑植骨。在接下来的几个月里，患者逐渐恢复了运动力量，四肢的功能使用也得到了改善。2011年3月，下肢（双侧）和右臂力量为5级，左臂力量为4+级。结论 本病例报告表明，对于1型神经纤维瘤病相关脊柱后凸患者的假关节形成、进行性脊柱畸形和脊髓受压等难题，存在一种潜在的局部治疗选择，可使畸形导致的四肢瘫痪几乎完全逆转。
