Heyde C E, von der Höh N, Völker A
Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
Oper Orthop Traumatol. 2024 Feb;36(1):33-42. doi: 10.1007/s00064-023-00828-4. Epub 2023 Sep 13.
Correction of a pathological kyphosis to restore a balanced, low-pain or pain-free and load-bearing spine.
Pronounced sagittal imbalance, progressive kyphosis despite conservative therapy, and neurological deficits are indications for surgery. Further surgical indications are severe therapy-resistant complaints and/or psychologically burdening cosmetic impairment. The guidelines for surgical indications are kyphosis angles of 75-80° thoracic and 30-50° lumbar.
No specific, but general contraindications for surgical treatment.
Depending on the characteristics of the kyphosis, different surgical techniques are used. Rod-screw systems are mainly used, and surgery is primarily performed by shortening the spinal column from posterior using a wide variety of techniques. In individual cases, this can be combined with ventrally mobilizing, resecting, or straightening techniques.
The aim of surgical treatment is to achieve a primarily stable and weight-bearing spine. Regular wound control as well as stabilizing physiotherapy during follow-up are essential. Postoperatively, initially abstaining from sports; later physical activity is encouraged under professional guidance.
The literature shows very good corrective results in children and adolescents. The technical procedures are associated with a low and acceptable complication rate. Over the course of time, these patients must be monitored in order to detect possible long-term complications such as junctional kyphosis or pseudarthrosis.
矫正病理性后凸畸形，以恢复脊柱的平衡、低疼痛或无痛状态以及承重功能。
明显的矢状面失衡、尽管进行了保守治疗仍进展性后凸畸形以及神经功能缺损是手术适应症。进一步的手术适应症是严重的治疗抵抗性主诉和/或造成心理负担的外观损害。手术适应症的指南为胸椎后凸角75 - 80°和腰椎后凸角30 - 50°。
无特定的手术治疗禁忌症，但有一般的手术治疗禁忌症。
根据后凸畸形的特点，采用不同的手术技术。主要使用棒 - 螺钉系统，手术主要通过多种技术从后方缩短脊柱来进行。在个别情况下，这可与前方松解、切除或矫直技术相结合。
手术治疗的目的是实现脊柱基本稳定且能承重。定期伤口检查以及随访期间稳定的物理治疗至关重要。术后，最初避免运动；之后在专业指导下鼓励进行体育活动。
文献显示儿童和青少年的矫正效果非常好。技术操作的并发症发生率低且可接受。随着时间推移，必须对这些患者进行监测，以发现可能的长期并发症，如交界性后凸畸形或假关节形成。
