重度脊柱畸形的定义目前仍存在分歧，过去一般认为脊柱侧凸Cobb’s角〉80°即为重度脊柱侧凸，如果同时合并凸侧Bending像上柔韧性90°～100°，伴或不伴脊柱后凸畸形[2-3]。笔者认为，一味强调畸形角度的大小有失偏颇，而应该全面关注畸形的程度、僵硬度、心肺功能及营养状况、既往治疗史以及伴随的椎管内脊髓病变，将其定义为重度复杂脊柱畸形可能更为恰当。20世纪70、80年代，欧美国家的一些学者开始关注重度脊柱畸形，并发表了一系列相关研究[4-8]。然而，随着对畸形早期治疗的重视，欧美国家的重度脊柱畸形患者逐渐减少。相反，诸如中国等发展中国家，由于经济和医疗体制原因，部分脊柱畸形患者，尤其是早发型脊柱侧凸（ early onset scoliosis，EOS ）早期未能得到恰当处理，使得目前有一大批重度脊柱畸形患者急需诊治。对于我国脊柱外科医生而言，重度脊柱畸形的处理面临巨大挑战，其在诸多方面尚存不少问题，值得关注。重度脊柱畸形的处理是当前脊柱外科的难点，其围手术期处理、治疗方式的选择以及预后仍存在诸多争议，笔者结合自己有限的临床实践，就相关问题谈谈个人的粗浅看法，以供同道参考。

Severe spinal deformity is not an uncommon condition that often arises from untreated early onset scoliosis in developing countries. Patients most often present with severe clinical and radiographic deformity with poor pulmonary function. Previous literature has identiifed the challenges in the treatment of these patients and the higher risk for complications. An assessment of the preoperative, intraoperative, and postoperative factors leading to an optimal result was warranted. The early evaluation should include a multidisciplinary approach from orthopaedic surgeon, pulmonologist, anesthesiologist, and perhaps neurologist to provide a baseline assessment. Advanced imaging of the spine is useful and important. Current surgical strategies include aggressive anterior and posterior column release and osteotomies, either with a front–back or a posterior-only approach. With the extent of the surgical release and segmental instrumentation, the potential for curve correction is in

目的：探讨脊柱-骨盆曲线和谐角（curve harmony angle, CHA）在量化矢状面相邻弯曲间相关性的作用，并评估其用于评价脊柱畸形矢状面平衡的可行性。方法收集93名正常志愿者及95例脊柱畸形患者（包括退变性脊柱侧凸、特发性脊柱侧凸及强直性脊柱炎）的影像学资料，测量常见脊柱-骨盆矢状面局部参数和整体参数，并对其进行相关分析。测量脊柱-骨盆曲线和谐角，包括颈胸和谐角（cervical-thoracic angle，CTA）、胸腰和谐角（thoracic-lumbar angle，TLA）和腰骶和谐角（lumbar-sacral angle，LSA），比较正常人及不同畸形患者间CHA的特征性改变。根据Schwab-SRS成人脊柱畸形分型矢状面参数进行分组，比较不同矢状面平衡状态下CHA的改变，以检验CHA评价脊柱畸形矢状面平衡的可行性。结果正常志愿者与各类型脊柱畸形患者常用脊柱骨盆参数呈现典型改变。CHA在不同类型的脊柱畸形中呈特征性改变。与正常组比较，退变性脊柱侧凸组与强直性脊柱炎组均表现CTA与LSA减小、TLA增大，且强直性脊柱炎组变化程度更为显著；特发性侧凸组仅TLA减小，而CTA及LSA与正常组的差异无统计学意义。矢状面代偿平衡组较平衡组有较小的LSA，失衡组较平衡组有较小的CTA与LSA和较大的TLA，CHA能反映各代偿阶段的特征性改变。结论 CHA可用于量化描述矢状面相邻弯曲间的关系。正常人、各类型脊柱畸形、以及不同平衡状态下CHA表现出不同的特点，其用于临床矢状面平衡及畸形矫正效果的评估具有可行性。

Objective To introduce Curve Harmony Angle (CHA)to quantify the relationship between adjacent curves of the spine and pelvis and evaluate sagittal balance in spinal deformities. Methods Radiographic analysis of 93 asymptomatic vol-unteers and 95 patients including Degenerative Scoliosis(DS), Adolescent Idiopathic Scoliosis(AIS)and Ankylosing Spondylitis (AS)was performed by measuring sagittal parameters. Correlation study among parameters was further conducted. Curve Harmony Angles(CHAs)including the following three parameters were measured. Cervical-Thoracic Angle (CTA), Thoracic-Lumbar Angle (TLA) and Lumbar-Sacral Angle (LSA). Comparative study between normal population and different spinal disorders were per-formed in order to describe the characteristic changes of CHAs. Besides, according to Schwab SRS adult deformity classification, comparative study of CHAs in different balance status was performed to test the reliability of CHA on sagittal balance evaluation. Results All subjec

重度脊柱畸形的治疗一直是脊柱外科面临的挑战，由于该类患者多合并心肺功能障碍，严重畸形又导致脊柱僵硬，使得手术矫形难度大、手术时间长和失血量大，患者围手术期各种并发症发生率明显增加[1]。由于术前牵引不但可以增加脊柱、胸廓和脊柱前方结构的柔韧性，还可以改善患者心肺和消化功能、了解牵引状态下脊髓耐受能力及神经并发症的发生情况，因此越来越多的学者采用牵引技术辅助治疗重度脊柱畸形[2-3]。现就目前临床上应用最多的Halo牵引技术综述如下。

Treatment of severe spinal deformity remains a challenge for spine surgeons. Significant pulmonary dysfunction is frequently present, which makes the procedures more daunting. Current surgical strategies include aggressive anterior and posterior column release and osteotomy, either with a front–back or a posterior-only approach. Satisfactory correction results can be achieved. However, the risk of nerve injuries may be increased due to the rapid and strong correction and graft failure may occur because of the increased stress caused by osteopenia. Therefore, the preoperative Halo traction is recommended in the treatment of severe spinal deformity. Both spinal deformity correction and pulmonary function can be improved, and the Halo traction is a helpful adjuvant in the treatment of severe spinal deformity. In this review, the types of Halo traction used mostly in clinical practice and their beneifts are summarized.

目的：探讨脊柱后凸畸形的手术方法和治疗体会。方法：应用经椎弓根椎体截骨Gss内固定术治疗脊柱后凸畸形共33例。结果：随访6～28个月，术前Cobb角37°～83°，平均57°，术后Cobb角平均12．5°，平均矫正44．5，°矫正率781．％。结论：经椎弓根椎体截骨结合Gss内固定术是治疗脊柱后凸畸形满意和可靠的方法。

Absrtact Objective:To discuss the operative technique and therapeutic experience in corrction of kyphosis deformity .Method s:There had been 33 cases of kyphosis deformity accepted the treatment of transpedicular vertebral osteotomy and Gss internal fixation .Re sul ts:All cases were followed-up 6 to 28 monthes, the Cobb angle was 37°to 83°before operation with average Cobb angle 57°,after operation the av-erage Cobb angle was 12.5°.The average correction was 44.5°and the correcting rate was 78.1%.Conclusion:Application of transpedicu-lar vertebral osteotomy and Gss internal fixation in correction of kyphosis deformity might be a liable and safe surgical technique .

脊柱侧弯是指脊柱的一个和多个节段偏离人体中线,向侧方弯曲形成弧度,以致胸廓、骨盆甚至下肢的长度发生变化.该类患者多行脊柱侧弯矫形术,已达到防止畸形进一步发展、矫正畸形,使外观得以改善,生活质量得以提高的目的[1].我院近期收治1例脊柱侧弯矫形术后内固定物取出的患者,此类病例很是少见,其手术配合方面面临很多问题,现报道如下.

@@