Abstract：Objective To examine the efficacy of posterior vertebral column resection and release in treatment of severe congenital angular kyphosis.Methods From February 2004 to February 2012, 14 patients with severe congenital angular kyphosis deformity were treated surgically by posterior vertebral column resection and release. There were 5 males and 9 females with an average age of 20.6 years (range from 14 to 42 years old). There were 3 cases of anterior failure of vertebral body segmentation, 8 cases of anterior failure of formation and 3 cases of combination of anterior failure of formation and segmentation. The local deformity was assessed by the Cobb method. The preoperative kyphosis angle was from 91° to 155°,with an average of 109.4°. The average preoperative sagittal imbalance was 0.9 cm, ranging from -0.1 to 5.5 cm. Thirteen patients also had scoliosis and the mean Cobb angle was mean 67.5°(range from 11°to 128°). The coronal imbalance ranged from 0 to 6.5 cm, average of 2.6 cm. There were 2 cases who had neurologic deficits in the 8 patients with hemivertebrae. According to Frankel grading system, one patient was classified as grade C and the other grade D. The preoperative score of the Oswestry disability index(ODI) was 0-45 points, average of 16.8.Results The average surgery time was 6.9 hours (5.6-10.7 hours) with average blood loss 3 160 ml (1 400-5 100 ml) . The average spinal shortening was 2.4 cm (range from 1.9 to 2.9 cm). The average fusion segments were 10.4, ranging from 6 to 14 segments. All patients were followed up for 24-96 months, average of 44.9 months. At the most recent follow-up, the kyphosis Cobb angle was corrected to 26.4°(range from 9° to 44°),with a correction rate of 75.8%. The sagittal imbalance was corrected to 0.09 cm(range from -0.8 to 0.5 cm), with a correction rate of 89.8%. The scoliosis Cobb angle was corrected to 17.2°(range from 0° to 55°), with a correction rate of 74.6%. The coronal imbalance was corrected to 0.5 cm (range from 0 to 2.7 cm), with a correction rate of 81.3%. Two cases with preoperative neurologic deficits were recovered from grade C and D to grade E according to Franckel classification system. Bony fusion was achieved in all patients. There was no spinal cord injury. The ODI was improved to 0.2 (range from 0 to 2), with a 98.8% improvement rate.Conclusions The technique of posterior release and vertebral column resection effectively improves the spinal flexibility. Excellent deformity correction can be achieved. The technique is a safe and effective alternative for severe congenital angular kyphosis.
李超，付青松，周宇，于海洋，赵刚，崔西龙，兰魁勇，尹稳. 后路全脊椎切除与松解治疗先天性重度脊柱角状后凸[J]. 中华解剖与临床杂志, 2014, 19(4): 268-273.
Li Chao, Fu Qingsong, Zhou Yu, Yu Haiyang, Zhao Gang, Cui Xilong, Lan Kuiyong, Yin Wen. Posterior vertebral column resection and release in treatment of congenital severe angular kyphosis. Chinese Journal of Anatomy and Clinics, 2014, 19(4): 268-273.
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2014, Vol. 19 
