单节段截骨治疗椎体形成不良型脊柱侧后凸畸形的疗效分析

Efficacy of single-level osteotomy in the treatment of kyphoscoliosis of vertebral malformation type

摘要:

目的：分析应用单节段截骨治疗椎体形成不良型脊柱侧后凸畸形（congenital kyphoscoliosis，CKS）的临床疗效。方法：回顾性分析2006年7月至2012年5月应用后路单节段截骨椎弓根钉内固定治疗19例椎体形成不良型CKS患者，平均19.2岁，其中9例行经椎弓根椎体截骨术（pedicle subtraction osteotomy，PSO），10例行全椎体截除术（vertebra cloumn resection，VCR）。对比观察手术情况、影像学分析、疼痛视觉模拟评分（visual analogue scale，VAS）、美国脊髓损伤协会（American Spinal Injury Asso－ciation，ASIA）分级和并发症。结果：手术时间（302.1±43.2） min，术中出血（589.5±151.5） ml，平均融合节段6.0±1.5；术后侧凸角矫正率（79.7±9.2）%，局部后凸角矫正率（81.1±21.9）%，颈7垂线-骶骨中线距离（vertical line between the 7th vertebra and central sacra，C7-CSL）矫正率（82.7±12.5）%。上述指标在PSO组和VCR组间差异无统计学意义（P >0.05）。但术前局部后凸角VCR组62.2°±21.0°明显大于PSO组22.7°±22.0°，t=4.009，P=0.001。经过平均4.2年随访，所有患者脊柱侧凸角、局部后凸角及冠状面偏移未见明显进展，VAS改善（85.9±15.9）%，ASIA分级3例D均恢复至E。所有患者并发症发生率21.1%，1例硬脊膜损伤，2例单侧下肢麻木，1例慢性腰痛，随访期间所有患者植骨融合良好，无伤口感染、螺钉松动移位、内植入断裂发生。结论：一期后路单节段截骨椎弓根钉内固定治疗椎体形成不良型CKS安全可行，可获得良好的矫正效果，其中VCR术应用于脊柱矢状面矫形更有优势。

Abstract:

Objective：To evaluate the efficacy of single-level osteotomy in the treatment of malformation typed congenital kyphoscol－iosis（CKS）. Methods：Nineteen consecutive cases of malformation typed CKS patients from July 2006 to May 2012 with single-level osteotomy and posterrior pedicle screw fixation were investigated retrospectively，in which 9 cases were conducted by pedicle subtrac－tion osteotomy（PSO） and 10 cases were conducted by vertebra column resection（VCR）. The average age was 19.2 years and the av－erage follow-up time was 4.2 years. The surgical and radiographic information were comparatively analyzed. Visual Analogue Scale（VAS），the American Spinal Injury Association （ASIA） classification and the complications along the follow-up time were reviewed. Results：Mean operative time was （302.1±43.2） min with average blood loss of （589.5±151.5） ml and average fusion segment of 6.0±1.5. The correction rates of scoliosis Cobb’s angle，segmental kyphosis Cobb’s angle and distance of vertical line between the 7th vertebra and central sacra（C7-CSL） were （79.7±9.2）%，（81.1±21.9）%，（82.7±12.5）%，respectively. The parameters above were not significantly different between PSO group and VCR group except the preoperative segmental kyphosis Cobb’s angle（P >0.05），of which，PSO group was 22.7°±22.0°，VCR group was 62.2°±21.0°（t=4.009，P=0.001）. At last follow-up，no significant progress was observed in scoliosis Cobb’s angle，segmental kyphosis Cobb’s angle and C7-CSL. VAS improvement rate was （85.9±15.9）%. Three cases improved from D to E in ASIA classification. One case of cerebrospinal fluid leakage，two cases of unilateral numbness and one case of back pain were observed without any sign of wound infection or implant failure. Conclusion：Single-level osteotomy with posterior pedicle screw fixation is safe and feasible with ex－cellent correction. For sagittal correction，VCR procedure shows significant advantage.