目的 探讨青少年期(10～19岁)严重非创伤性、非炎症性颈椎长节段后凸畸形的个体化手术治疗方案.方法 回顾性总结分析2000年7月至2007年7月收治的12例年龄在12～19岁的颈椎长节段严重后凸畸形患者的临床资料和手术治疗过程及治疗效果.分析12例患者的影像学资料发现其共同点为:(1)后凸的顶椎位于C4或C5;(2)后凸弧内的椎体均前低后高呈楔形变及椎间隙明显变窄;(3)MRI显示与顶椎相对应的椎管均有不同程度的狭窄和硬膜囊受压.以下几种情况为不同病例的个体化特点:(1)合并C1.2旋转半脱位者2例;(2)合并C2半脱位2例;(3)C4～C7椎体严重营养不良2例;(4)C2～C5椎体严重营养不良1例;(5)C6.7椎间隙向前喇叭口样张开2例.结果 根据对每个病例特点的具体分析采用针对性的手术入路.前方入路2例,后方入路2例,后方入路联合前方入路7例,一期前-后-前入路1例.后凸Cobb角由手术前平均73°矫正至平均15°.随访3个月～6年,1例在融合固定的下端发生新的成角和节段性不稳,其余11例矫正度无明显丢失.3例瘫痪者均恢复正常神经功能.结论 对不同病因、不同畸形程度和不同继发性病理改变的青少年颈椎后凸畸形患者应采用合理的个体化的手术治疗方案才能有效地矫正畸形和解除脊髓压迫.%Objective To explore the rational individualized surgical procedure to treat nontraumat-ic and noninflammatory long-segment severe cervical kyphotic deformity in adolescent patients. Methods A retrospective review was made in 12 patients who suffered from long-segment severe cervical kyphotic defor-mity aged 12-19 years from July 2000 to July 2007. The common features in imaging materials were: 1.the top vertebra of kyphosis locating at C4or C5. 2. the vertebrae within the kyphotic curve wedged and interver-tebral space narrowing. 3. MRI showing spinal canal stenosis and dural compression at the top of kyphotic curve. The individual imaging characteristics as following: 1. C1-C2 rotary subluxation in 2 patients. 2. C2 an-terior subluxation in 2 patients. 3. C4-C7 vertebral severe malnutrion in 2 patients. 4. C2-C5 vertebral severe malnutron in 1 patient. 5. C6-C7 disc anteriorly open like trumpet mouth in 2 patients. Results Anterior approach alone in 2 patients, posterior approach alone in 2 patients, posterior approach combined with ante-rior approach in 7 patients, anterior-posterior-anterior approach in 1 patient. The kyphotic angle was correct-ed from average 73 degree to 15 degree. The follow-up duration was 3 months to 6 years, a new kyphosis occurred below the fused segment in 1 patient who was undergone anterior correction alone. The correction rate was not lost in the other 11 patients. The neurological function restored to normal level in 3 incomplete paraplegic patients. Conclusion Individualized surgical approach should be taken to treat long-segment se-vere cervical kyphotic deformity in adolescent patients because the pathogenesis, the degree of deformity, the secondary pathological change are different in every patient.
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