McCall R E
Shriners Hospitals for Children, Shreveport, Louisiana, USA.
Spine (Phila Pa 1976). 1998 Jun 15;23(12):1406-11. doi: 10.1097/00007632-199806150-00020.
Treatment of congenital kyphosis in myelomeningocele is a difficult problem. Current thinking supports kyphectomy and postoperative internal fixation.
Since 1989, vertebral resection with modified Luque fixation has been the procedure of choice for correction of myelomeningocele kyphotic deformity at the author's institution. The study objective was to evaluate long-term results with this technique.
Most investigators agree that kyphotic deformity in myelomeningocele should be treated with vertebral resection. There is less uniform consensus about postoperative fixation. Reports in the literature support fixation with modified segmental instrumentation.
Sixteen patients, observed for an average of 57.2 months (range, 36-94 months), underwent vertebral resection from the proximal aspect of the apical vertebra cephalad into the compensatory lordotic curve. Fixation was segmental instrumentation wired to the thoracic spine and anterior to the sacrum.
The average blood loss was 1121 mL (range, 450-2580 mL). Kyphotic deformity averaged 111 degrees before surgery (range, 75-157 degrees), 15 degrees after surgery (range, -18-36 degrees) and 20 degrees at latest follow-up (range, -17-83 degrees). Loss of correction was 6 degrees (range, 0-27 degrees). Postoperative immobilization was with a thoracolumbosacral orthosis for 18 months. Complications occurring in 8 of the 16 patients were transient headache, superficial wound breakdown, supracondylar femur fractures, and one late infection secondary to skin breakdown that necessitated early rod removal, resulting in some loss of correction.
Kyphectomy is an excellent method of correcting rigid kyphotic deformity in the patient with myelodysplasia. Segmental spinal instrumentation provided three distinct advantages: rigidity of the construct, greater correction of the deformity and low-profile instrumentation.
治疗脊髓脊膜膨出合并先天性脊柱后凸是一个难题。目前的观点支持行脊柱后凸切除术及术后内固定。
自1989年以来，在作者所在机构，采用改良鲁氏固定的椎体切除术一直是矫正脊髓脊膜膨出脊柱后凸畸形的首选术式。本研究的目的是评估该技术的长期效果。
大多数研究者认为脊髓脊膜膨出的脊柱后凸畸形应采用椎体切除术治疗。关于术后固定的意见则不太一致。文献报道支持采用改良节段性内固定。
16例患者平均随访57.2个月（范围36 - 94个月），接受了从顶椎近端向头侧直至代偿性前凸曲线的椎体切除术。固定方式为将节段性器械钢丝固定于胸椎及骶骨前方。
平均失血量为1121毫升（范围450 - 2580毫升）。术前脊柱后凸畸形平均为111度（范围75 - 157度），术后为15度（范围 - 18 - 36度），最近一次随访时为20度（范围 - 17 - 83度）。矫正丢失为6度（范围0 - 27度）。术后使用胸腰骶矫形器固定18个月。16例患者中有8例出现并发症，包括短暂性头痛、表浅伤口裂开、股骨髁上骨折，以及1例因皮肤破溃继发的晚期感染，需要早期取出内固定棒，导致部分矫正丢失。
脊柱后凸切除术是矫正脊髓发育不良患者僵硬性脊柱后凸畸形的一种优秀方法。节段性脊柱内固定有三个明显优点：内固定结构的刚性、更大程度的畸形矫正以及外形低调的内固定。
