中文摘要：

目的评价经后路一期全脊椎截骨术治疗重度脊柱侧后凸畸形的临床疗效及安全性。方法 2009-2014年本科对30例重度脊柱侧后凸患者进行手术治疗,包括男性19例,女性11例,平均年龄33.8（9-63）岁;其中胸段15例,腰段9例,胸腰段6例;脊柱特发性畸形12例,先天性畸形14例,陈旧性脊柱骨折1例,脊柱结核1例,脊柱侧凸术后翻修2例;术前平均冠状面Cobb角96.2°（81°-149°）,平均矢状面Cobb角99.6°（86°-153°）,平均顶椎偏移2.8（1.9-7.6）cm;Frankel分级D级3例,余为E级;8例存在中度呼吸功能障碍,22例存在明显胸背部疼痛症状。患者均行一期后路全脊椎截骨矫形术,术后评估神经功能及Cobb角改善等情况。结果手术顺利,平均手术时间4.6（3.5-6.0）h;平均出血量1 260（910-2 600）m L;术后平均冠状面Cobb角44.3°（33°-68°）,矫正率53.9%;平均矢状面Cobb角43.5°（35°-79°）,矫正率56%;平均顶椎偏移0.7（0.2-2.3）cm,矫正率75%;身高平均增长8.3 cm;2例Frankel分级由D级恢复到E级,术后1例由D级加重至B级,但末次随访时恢复至E级。围手术期出现1例脑脊液漏,经腰池引流后治愈。患者均获随访1年以上,无内固定松动、断裂等并发症出现。患者对手术效果和外形改善满意率达92%,22例患者胸背部疼痛明显缓解,其中18例3个月后完全消失。结论后路一期全脊椎截骨术治疗重度脊柱侧后凸畸形,临床疗效及安全性满意,但技术要求高,谨慎使用可获得满意疗效。

英文摘要：

Objective To evaluate the clinical efficacy and safety of one stage posterior total vertebral column resection in treatment of severe kyphoscoliosis. Methods Thirty patients with severe kyphoscoliosis deformity（ 19 males and 11 females,at an average age of 33. 8,ranging from 9 to 63） admitted in our department from January 2009 to December 2014 were subjected in this study. They were surgically treated with one stage posterior total vertebral column resection and fusion. There were 15 cases of deformity on thoracic segments,9 cases on lumbar segments and 6 cases on thoracolumbar segments. Of them,12 with idiopathic deformity,14 with congenital deformity,1 with old vertebral fracture,1 with spinal tuberculosis,2with scoliosis revision surgery. The pre-operative scoliosis Cobb angle was 96. 2°（ 81° - 149°）,kyphosis Cobb angle was 99. 6°（ 86° - 153°）,and apical offset 1. 9 - 7. 6 cm（ mean 2. 8 cm）. According to Frankel grading system,3 patients were classified as grade D,and the others were grade E. Eight cases had mild respiratory dysfunction,and 22 cases had obvious chest pain. All patients underwent one stage posterior vertebral column resection,evaluation of nerve function and the improved Cobb angle after operation. ResultsThe operation went smoothly,with an average surgery time of 4. 6（ 3. 5 - 6. 0） h and average bleeding volume of 1 260（ 910 - 2 600） mL. The post-operative scoliosis Cobb angle was 44. 3°（ 33° - 68°,in a correction rate of 53. 9%） and kyphosis Cobb angle was 43. 5°（ 35° - 79°,in a correction rate of 56%）. The average apical offset was 0. 7（ 0. 2 - 2. 3） cm,and the correction rate was 75%. The average height growth was 8. 3 cm. There were 2 cases of Frankel grade recovery from D to E,and 1 case changed from D to B achieved,but recovered to E at the final follow-up. Cerebrospinal fluid leakage was observed in 1 case during the perioperative period, and the patient was cured after lumbar cistern drainage. No internal fixation loosening,fracture or o