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find Keyword "半椎体" 8 results
  • 短节段截骨融合在半椎体畸形中的初步应用

    目的 总结半椎体切除、短节段固定及截骨融合术治疗半椎体畸形的疗效。 方法1998年8月-2009年4月,采用后路半椎体切除、短节段固定及截骨融合术治疗9例胸腰段后外侧1/4半椎体畸形。男3例,女6例;年龄11~15岁,平均13.1岁。T8右侧1例,T9左侧1例,T10右侧2例,T12右侧2例,L1右侧2例,L2右侧1例。Cobb角(59.4 ± 2.8)°;C7偏离骶正中线11~32 mm,平均19 mm;胸椎代偿弯Cobb角(21.0 ± 3.4)°。MRI检查未见脊髓明显畸形。 结果术后切口均Ⅰ期愈合,未出现神经系统并发症。X线片复查示脊柱畸形均明显改善,植骨均融合,融合时间2~4个月。9例均获随访,随访时间24~56个月,平均40个月。术后3个月侧凸均显著改善,Cobb角(16.8 ± 1.9)°;末次随访Cobb角未丢失,为(18.6 ± 2.7)°;与术前比较差异均有统计学意义(P lt; 0.05)。无断钉、断棒等并发症发生。 结论半椎体切除、短节段固定及截骨融合术创伤小,可以纠正侧凸畸形、平衡脊柱,是治疗半椎体畸形的有效方法之一。

    Release date:2016-08-31 05:39 Export PDF Favorites Scan
  • FAILURE CAUSE OF POSTERIOR APPROACH ORTHOPAEDIC OPERATION OF THORACOLUMBAR HEMIVERTEBRA AND STRATEGIES OF REVISION

    Objective To explore the failure cause of posterior approach orthopaedic operation of thoracolumbar hemivertebra, and to summary strategies of revision. Methods The cl inical data from 9 cases undergoing posterior approach orthopaedic operation failure of thoracolumbar hemivertebra between June 2003 and June 2008, were retrospectively analyzed. There were 5 males and 4 females with a median age of 12 years (range, 1 year and 10 months to 24 years). All malformations were identified as fully segmented hemivertebra from the original medical records and X-ray films, including 2 cases in thoracic vertebra, 5 cases in thoracolumbar vertebra, and 2 cases in lumbar vertebra. The preoperative scol iotic Cobb angle was (45.4 ± 17.4)°, and kyphotic Cobb angle was (29.8 ± 22.0)°. The reason of primary surgical failure were analyzed and spinal deformity was corrected again with posterior revision. Results All surgeries were finished successfully. The operation time was 3.0-6.5 hours (mean, 4.5 hours), and the perioperative bleeding was 400-2 500 mL (mean, 950 mL). All incisions healed by first intention; no infection or deep venous thrombosis occurred. Numbness occurred in unilateral lower extremity of 1 case postoperatively, and the symptom was rel ieved completely after treatment of detumescence and neural nutrition. All cases were followed up 12-30 months (mean, 18 months). No pseudoarthrosis and implant failure occurred. The X-ray films showed that the bone grafts completely fused within 8-14 months (mean, 11 months) after operation. The Cobb angles of scol iosis and kyphosis at 1 week after operation and the last follow-up were obviously improved when compared with preoperative ones, showing significant differences (P lt; 0.05). No obvious correction loss was observed either in coronal or sagittal plane. Conclusion The failure causes of posterior approach orthopaedic operation are hemivertebra processing, selection of fixation and fusion range, and selection of internal fixation. If the strategies of revision are made after the above-mentioned failure causes are considered, the cl inical results will be satisfactory.

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • 后路截骨矫形内固定治疗青少年胸椎半椎体合并脊髓纵裂脊柱侧凸畸形

    目的 总结青少年胸椎半椎体合并脊髓纵裂的手术治疗方法。 方法 2003 年1 月- 2007 年12 月,应用一期后路半椎体、骨嵴切除,椎弓根钉棒系统内固定、自体骨植骨融合治疗下胸椎脊柱侧凸合并脊髓纵裂患者15 例。其中男6 例,女9 例;年龄16 ~ 24 岁,平均21.2 岁。均为先天性完全分节半椎体,脊髓纵裂均位于半椎体。病椎位于T11 3 例,T12 12 例。病程9 ~ 61 个月,平均22 个月。术前侧凸Cobb 角48.6 ~ 106.4°,平均52.3°。 结果 术中无脊液漏,无胸膜损伤。切口Ⅰ期愈合14 例;1 例发生感染,经抗炎、切口换药后愈合。15 例均获随访,随访时间9 ~ 45 个月,平均34 个月。术后10 个月Cobb 角0 ~ 14°,平均10.2°,矫正率平均76.3%,术后脊柱畸形明显改善。术后X 线片示患者均获良好骨融合,融合时间3 ~ 5 个月。无内固定失败及假关节形成。 结论 一期后路手术截除半椎体及纵裂骨嵴可达到脊柱矫形目的,同时完成截骨间隙植骨融合以重建脊柱稳定性,是一种治疗完全分节的胸椎半椎体合并脊髓纵裂脊柱侧凸畸形的有效方 法。

    Release date:2016-09-01 09:07 Export PDF Favorites Scan
  • IMPACT OF SURGICAL OPPORTUNITY ON EFFECTIVENESS OF POSTERIOR HEMIVERTEBRA RESECTION FOR CONGENITAL SPINAL DEFORMITY

    ObjectiveTo investigate the optimal surgical opportunity timing of posterior hemivertebra resection by comparing the outcomes of surgical treatment for congenital spinal deformity in patients at different ages. MethodsBetween January 2007 and Februay 2013, 36 cases of congenital hemivertebra scoliosis underwent one-stage posterior hemivertebra resection and segmental instrumentation fixation and fusion. There were 22 males and 14 females, with an average age of 16.8 years (range, 5-48 years). The patients were divided into 3 groups:group A (≤10 years, n=7), group B (10-20 years, n=22), and group C (>20 years, n=7). There was no significant difference in gender, segment, type, and complication among 3 groups (P>0.05). Anteroposterior and lateral X-ray films were taken before and after operation to measure the scoliosis Cobb angle, kyphosis Cobb angle, and C7 plumb line-center sacral vertical line (C7PL-CSVL). The improvement rate was calculated. And the perioperative and long-term complications were recorded. ResultsThe operation time of group A was significantly less than that of group C (P<0.05); the intraoperative blood loss of group B and group C were significantly more than that of group A (P<0.05); and the fixed segments of group B and group C were significantly more than those of group A (P<0.05). Thirty-six cases were followed up 7-62 months (mean, 31.3 months). No poor wound healing, pedicle cutting, pseudoarticulation formation, and other complications occurred during the follow-up. At last follow-up, 31 patients obtained a balance of double shoulders and double hips. The scoliosis Cobb angle, kyphosis Cobb angle, and C7PL-CSVL at immediate after operation and last follow-up were significantly improved when compared with preoperative ones in 3 groups (P<0.05). The scoliosis Cobb angle at last follow-up of group B was significantly larger than that of group C, the kyphotic correction rate at immediate after operation was significantly larger in groups A and C than in group B, the kyphotic correction rate of group B at last follow-up was significantly less than that of group C, and C7PL-CSVL correction rate of group A at immediate after operation was significantly larger than that of group B, all showing significant differences (P<0.05). ConclusionEarly one stage posterior hemivertebra resection is safe and effective, especially in patients who had no formation of structural compensatory bending and spinal stiffness, which can shorten the operation time and reduce the fixed segments and intraoperative hemorrhage. Influence on the growth and activity of the spine is relatively small.

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  • PROGRESS OF ONE-STAGE POSTERIOR HEMIVERTEBRA RESECTION FOR CONGENITAL KYPHOSCOLIOSIS

    ObjectiveTo summarize the research progress of one-stage posterior hemivertebra resection for congenital kyphoscoliosis. MethodsThe domestic and foreign related literature about spinal hemivertebra deformity,and many aspects of its operation mode,operation timing,the fixed segment,and operation complications were summarized and analysed. ResultsThe hemivertebra resection can remove teratogenic factors directly,and is favor by the majority of domestic and foreign physicians,but the procedure,indications,long-term effectiveness,and postoperative complications are still unconcern,and the operation timing and fixed-fused segment is still controversial. ConclusionThe operation timing and the fixed segment of one-stage posterior hemivertebra resection for congenital kyphoscoliosis need further research.

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  • TREATMENT OF CONGENITAL KYPHOSCOLIOSIS WITH SELECTIVE-PARTIAL HEMIVERTEBRA RESECTION AND INSTRUMENTATION VIA POSTERIOR APPROACH

    ObjectiveTo investigate the effectiveness of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis. MethodsBetween January 2008 and August 2011, 17 patients with congenital kyphoscoliosis were treated by selective-partial hemivertebra resection and instrumentation via posterior approach. There were 10 boys and 7 girls with the mean age of 10.8 years (range, 9-14 years). Of them, 15 cases had lumbar back pain, and 3 cases had lower limb numbness of nervous system damage symptoms. Risser sign was rated as grade 0 in 3 cases, grade 1 in 2 cases, grade 2 in 7 cases, and grade 3 in 5 cases. The classification of deformity was fully segmental hemivertebra. The deformity located at the thoracic segment in 9 cases, at the thoracolumbar segment in 4 cases, and at the lumbar segment in 4 cases. The Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were measured at pre-operation, at 10 days after operation, and last follow-up to evaluate the correction effect. ResultsThe 2-7 segments (mean, 3.7 segments) were fixed. The operation time was 4-6 hours (mean, 4.77 hours). The intraoperative bleeding was 300-1 100 mL (mean, 611.76 mL). All incisions healed by first intention, with no infection or complication of nervous system. All patients were followed up 6-37 months (mean, 20.12 months). Back pain and numbness of lower limbs were eliminated. X-ray films showed complete bone graft fusion at 6-18 months (mean, 12 months). At 10 days after operation and last follow-up, the Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were significantly decreased compared with the preoperative angles (P<0.05); the Cobb angles of the main curves and segmental curves at last follow-up were significantly greater than those at 10 days after operation (P<0.05) except the segmental kyphotic curves angle (P>0.05). Postoperative correction rates of the Cobb angles of the segmental curve, the main curves, and segmental kyphotic curves were 64.35%±0.07%, 65.08%±0.07%, and 72.26%±0.11%, respectively; loss of correction was (3.04±1.17), (2.81±0.93), and (0.75±0.50)°, respectively. ConclusionFor patients at the age of 9-14 years, with the Risser sign between grade 0-3, and with the Cobb angles less than 60°, the selective-partial hemivertebra resection and instrumentation via posterior approach can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.

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  • 增强现实技术联合 3-D 打印技术行半椎体置换治疗椎体肿瘤一例

    目的 总结增强现实(augmented reality,AR)技术联合 3-D 打印技术行半椎体置换治疗椎旁巨大神经鞘膜瘤 1 例经验。 方法 2017 年 3 月收治 1 例 66 岁男性椎旁巨大神经鞘膜瘤患者。术前 CT 增强扫描显示,脊柱腰骶部右侧旁盆腔内见一 8.9 cm×7.8 cm×7.6 cm 大小的不均匀明显强化肿块。利用 Mimics 软件处理 CT 扫描数据,模拟手术切除肿瘤,设计 L5、S1 椎体模型,并 3-D 打印钛合金椎体。术中术者佩戴导入了术前重建 AR 影像的 Hololens 眼镜,彻底切除肿瘤后,植入打印钛合金椎体。 结果 患者手术顺利完成,手术时间 245 min,术中出血量约 1 200 mL。术后病理检查结果示:(腹膜后脊柱旁)神经鞘瘤。术后 6 个月随访,患者疼痛视觉模拟评分(VAS)由术前 5 分降至 2 分;X 线片及 CT 复查示钛金属椎体呈部分骨性融合,位置良好,无断裂、脱出,椎体无塌陷。 结论 应用 AR 技术辅助肿瘤切除,联合 3-D 打印假体置换治疗椎旁巨大肿瘤可行。

    Release date:2017-11-09 10:16 Export PDF Favorites Scan
  • Progress in surgical treatment of congenital scoliosis

    Congenital scoliosis is the presence of a sideways curvature of the spine caused by the failure of normal vertebral development. Congenital scoliosis is usually progressive, and surgical treatment is crucial for the treatment of congenital scoliosis. Surgical treatments of congenital scoliosis mainly include simple fusion surgery, hemivertebrae excision, growing rods technique, and vertical expandable prosthetic titanium rib. However, there is no uniform standard for the selection of surgical techniques and surgical timing. This article reviews the progress of different surgical treatments for congenital scoliosis, introduces the classification of congenital scoliosis, and clarifies the timing, pros and cons of different surgical techniques, aiming to provide a reference for the development of individualized optimal surgical plans for patients with congenital scoliosis.

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