胸腰椎后凸畸形患者改良后椎柱切除术
Summary
我们描述了一种基于改良环钻单侧切除后椎柱的改良技术，用于胸腰椎后凸畸形患者。
Abstract
陈年压迫椎骨骨折或先天性脊柱后侧凸伴椎体发育异常等侵入脊柱的疾病，可引起严重的胸腰椎后凸畸形，常伴有顽固性腰痛或脊髓受压，导致严重的神经系统症状甚至瘫痪。如果保守治疗不能缓解症状或矫正畸形，通常需要手术治疗。对于严重的后凸畸形，生理曲率的重建和刚性固定决定了患者的预后。截骨术和骨科是前柱和中柱严重受压的畸形的标准程序，但对患者的创伤很大，手术时间长，大量失血。为了避免这些缺点，我们开发了一种改良技术来单方面切除患病的椎骨。在这种技术中，我们使用改良的环钻来切除椎体柱，就像在椎弓根螺钉技术中一样，通过添加可以限制环钻的锁定器械来降低截骨术的风险并缩短手术时间和失血量。
Introduction
胸腰椎后凸畸形是原发性或继发性疾病，通常由椎骨骨折、椎体发育、强直性脊柱炎和脊柱结核1，2，3，4引起。严重的后凸畸形通常诱发脊髓压迫或严重的腰痛。一旦保守治疗无效，由于畸形引起的并发症，有必要采用手术方法。然而，适当的手术治疗仍然存在争议。
治疗严重后凸畸形的手术方法通常需要 3 级或更高的5 级截骨术。椎弓根减影截骨术（PSO）是一种可以实现三柱截骨术的技术，据报道矫正在30°至40°6之间。当后凸畸形超过40°时，建议进行椎柱切除术，但可缩短脊柱并诱发脊髓体积7。部分椎体和椎间盘切除术（BDBO;4级）和后椎柱切除术（PVCR;5级）需要完全截留脊柱的前柱和中柱，这可能会对脊柱造成巨大损伤，并因手术中的脊柱不稳定或术后种植体沉降而引起严重的神经系统并发症7，8.对于一般操作者来说，该技术很难掌握，手术对患者的伤害是巨大的。因此，需要一种更容易执行且损坏更小的方法。
在本报告中，我们介绍了一种改进的手术技术，即改良环钻，通过单侧切除椎间盘和相邻椎间盘并在同一侧放置带有自体骨的钛网来治疗胸腰椎后凸。该技术旨在最大限度地减少对患者的伤害，同时取得良好的效果。在我们之前的研究中，精细的外科手术显示出显着更大的结果，并通过保留对侧椎弓根和部分椎体来减少对脊柱的损害9。
Protocol
该方案遵循河北医科大学第三医院伦理委员会的指导方针。从患者那里获得了知情同意，以包括他们和作为本研究一部分生成的数据。 1.术前准备 根据以下纳入和排除标准选择患者。对于接受手术的患者，纳入标准如下：1）胸腰椎后凸引起的神经压迫，2）脊柱后凸引起的严重腰痛，3）Kummell病患者，4）治愈传染病留下的脊柱后凸畸形。排除标准如下：1?…
Representative Results
使用单侧PVCR技术可以实现约330°减压。需要切除横突和肋骨头，以确保外展角足以切除对侧骨。 通过使用改良的环钻，可以通过以轻微的压力旋转来轻松去除患病椎骨的骨骼。当环钻被锁定时，应将环钻和探头一起拉出，然后可以获得一圆柱体的松质骨（图2）。 并非所有患者都需要在截骨术段植入椎弓根螺钉。对于一些轻度椎体?…
Discussion
协议中提到的放置临时固定杆的步骤和畸形矫正是手术过程中的关键步骤。通过保留椎弓根的一侧并加载临时固定杆，可以在截骨术过程中保持稳定性。在畸形矫正的手术过程中，必须保护神经根，以防止严重的术后神经系统并发症。如果外科医生不确定神经根的位置，则需要在切除椎板和关节过程后暴露神经根。当切除椎管壁时，由于静脉丛，失血量可能很大。虽然使用双极电凝止血可以减少?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
没有。
Materials
| Adhesive | Biatain | 3420 | 12.5 cm x 12.5 cm |
| Bipolar electrocoagulation tweezers | Juan'en Medical Devices Co.Ltd | BZN-Q-B-S | 1.2 mm x 190 mm |
| Bone wax | ETHICON | W810T | 2.5g |
| Curette | Qingniu | 20739.01 | 300 x Ø9 x 5° |
| Double jointed forceps | SHINVA | 286920 | 240 mm x 8 mm |
| High frequency active electrodes | ZhongBangTianCheng | GD-BZ | GD-BZ-J1 |
| Laminectomy rongeur | Qingniu | 2054.03 | 220 x 3.0 x 130° |
| Laminectomy rongeur | Qingniu | 2058.03 | 220 x 5.0 x 130° |
| Pedicle screw | WEGO | 800386545 | 6.5 mm x 45 mm |
| Pedicle screw | WEGO | 800386550 | 6.5 mm x 50 mm |
| Pituitary rongeur | Qingniu | 2028.01 | 220 mm x 3.0 mm |
| Pituitary rongeur | Qingniu | 2028.02 | 220 mm x 3.0 mm |
| Rod | WEGO | 800386040 | 5.5 mm x 500 mm |
| Surgical drainage catheter set | BAINUS MEDICAL | SY-Fr16-C | 100-400 mL |
| Surgical film | 3L | SP4530 | 45 cm x 30 cm |
| Titanium cage | WEGO | 9051228 | 19 mm x 80 mm |
| Trephine | NATON MEDICAL GROUP | DJD04130 | 12 mm/10 mm |
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Cite This Article
Tian, X., Huo, Y., Han, F. Y., Yang, D., Ding, W., Yang, S. Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity. J. Vis. Exp. (187), e64465, doi:10.3791/64465 (2022).