C7-T1 前路闭合楔形骨-椎间盘-骨截骨术治疗肌营养不良症中的颈椎前凸：一种矫正罕见畸形的新技术

C7-T1 anterior closing wedge bone-disc-bone osteotomy for the treatment of cervical hyperlordosis in muscular dystrophy: a new technique for correction of a rare deformity.

作者信息

Kose Kamil Cagri, Caliskan Islam, Bal Emre, Inanmaz Mustafa Erkan, Isik Cengiz

机构信息

*Faculty of Medicine, Department of Orthopedics and Traumatology, Marmara University, Istanbul, Turkey †Faculty of Medicine, Department of Orthopedics and Traumatology, Sakarya University, Sakarya, Turkey ‡Department of Orthopedics and Traumatology, Bahcelievler Devlet Hst §Faculty of Medicine, Department of Orthopedics and Traumatology, Bolu Abant Izzet Baysal University, Bolu, Turkey.

出版信息

Spine (Phila Pa 1976). 2014 Aug 15;39(18):E1066-72. doi: 10.1097/BRS.0000000000000433.

DOI:10.1097/BRS.0000000000000433

PMID:24859582

Abstract

STUDY DESIGN

A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of the cervical spine in patients with muscular dystrophy presenting clinically with debilitating hyperlordosis is described, and 3 cases are reported.

OBJECTIVE

To describe a new surgical technique with emphasis on the clinical results and the effect of osteotomy on sagittal balance, gaze angle, and spinopelvic parameters.

SUMMARY OF BACKGROUND DATA

Previous reports of cervical osteotomy essentially have described opening wedge (extension osteotomy) for correction of severe flexion deformities. To the authors' knowledge, C7-T1 closing wedge osteotomy to correct hyperextension deformity due to muscular dystrophy in the cervical spine has not been described previously.

METHODS

Three male patients aged 16, 16, and 21 years presented with cervical hyperlordosis due to Becker muscular dystrophy. There was upward deviation of forward gaze in all patients. Anterior closing wedge (bone-disc-bone) osteotomy of C7-T1 was performed followed with a posterior release correction and instrumented stabilization. The chin-brow angle was visualized with the aid of fluoroscopy during the operation. After closure and posterior fixation, patient was turned supine again and the osteotomy site was grafted and fixed with a plate to further strengthen the construct and to prevent any translation.

RESULTS

The gaze angles and both sitting and standing postures of the patients markedly improved. There was documented fusion at the osteotomy sites. The patients were free of complaints at the last follow-up.

CONCLUSION

Bone-disc-bone closing wedge osteotomy done at C7-T1 level is a technically demanding procedure but results in significant acute clinical and radiological improvement in patients with hyperextension deformity of the cervical spine.

LEVEL OF EVIDENCE

摘要

研究设计

描述了一种新的颈椎闭合楔形截骨手术技术，用于矫正临床上因严重腰椎前凸而出现颈椎后伸畸形的肌营养不良患者，并报告了3例病例。

目的

描述一种新的手术技术，重点关注临床结果以及截骨术对矢状面平衡、注视角度和脊柱骨盆参数的影响。

背景资料总结

先前关于颈椎截骨术的报道主要描述了用于矫正严重屈曲畸形的开放楔形（伸展截骨术）。据作者所知，此前尚未描述过通过C7-T1闭合楔形截骨术来矫正颈椎肌营养不良引起的过伸畸形。

方法

3例男性患者，年龄分别为16岁、16岁和21岁，因贝克肌营养不良出现颈椎前凸。所有患者均有向前注视向上偏斜。进行了C7-T1前路闭合楔形（骨-椎间盘-骨）截骨术，随后进行后路松解矫正和器械固定。术中借助荧光透视观察颏眉角。关闭切口并进行后路固定后，患者再次转为仰卧位，对截骨部位进行植骨并用钢板固定，以进一步加强结构并防止任何移位。