KYPHECTOMY IN PATIENTS WITH MYELOMENINGOCELE: SURGICAL RESULTS AND COMPLICATIONS

Objectives:The lumbar kyphosis in patients with myelomeningocele is a complex deformity whose treatment is mainly surgical. The objective of this study is to summarize the results and complications obtained by the group in 2012 with respect to this group of patients.Method:Performed a retrospective analysis of the medical records and radiographs of patients consecutively operated in 2012. The technique was originally described by Dunn-McCarthy and consists of kyphectomy and posterior fixation using S-shaped Luque rods through the foramina of S1 associated with pedicle screws in the thoracic spine.Results:Six patients were included in the study. The age at surgery was 11 years and 7±22 months and the weight was 29.1±11.9 kg. The procedure lasted 271±87 minutes, with the removal of one or two (mean 1.5) vertebrae from the apex of the kyphosis. Hospitalization time was 10±9 days. The lumbar kyphosis measuring 116.3±37 degrees preoperatively was reduced to 62.5±21 degrees. All patients began to sit without support and to lie in the supine position. Four patients developed postoperative infection and required surgical debridement at the follow-up. One patient had the implant removed after a year due to loosening of the rod in the sacrum.Conclusion:The surgical technique allows excellent functional results in the correction of lumbar kyphosis in patients with myelomeningocele despite high complication rates. It is necessary to conduct studies with a larger number of patients and duration of follow-up to assess whether the use of pedicle screws will decrease the rate of loosening and pseudoarthrosis.

研究目的：脊髓脊膜膨出（myelomeningocele）患者伴发的腰椎后凸畸形（lumbar kyphosis）属于复杂畸形，临床治疗以手术为主。本研究旨在总结本团队2012年针对该类患者开展手术治疗的效果与并发症情况。
研究方法：对2012年连续接受手术治疗的患者的病历资料及X线影像资料进行回顾性分析。本次采用的手术技术最初由Dunn-McCarthy提出，具体为后凸截骨术（kyphectomy）联合后路固定术：经骶1椎间孔置入S形Luque棒（S-shaped Luque rods），并在胸椎节段搭配椎弓根螺钉（pedicle screws）。
研究结果：本研究共纳入6例患者。患者手术时的年龄为11岁7个月±22个月，体质量为29.1±11.9 kg。手术时长为271±87分钟，术中于后凸畸形顶点切除1~2个椎体（平均1.5个）。患者住院时长为10±9天。术前腰椎后凸角度为116.3±37度，术后矫正至62.5±21度。所有患者均可脱离支撑自行坐位及仰卧平躺。4例患者术后出现感染，随访期间需接受手术清创（surgical debridement）。1例患者因骶骨内棒体松动，于术后1年取出内固定装置。
研究结论：尽管并发症发生率较高，但该手术技术可在脊髓脊膜膨出合并腰椎后凸畸形的矫正中获得优异的功能恢复效果。未来需开展纳入更多患者、随访周期更长的研究，以评估椎弓根螺钉的应用是否可降低螺钉松动及假关节形成（pseudoarthrosis）的发生率。