顶椎区脊髓形态分型Ⅲ型的严重脊柱侧后凸畸形术前牵引对手术安全性的影响  

Severe kyphoscoliosis patients with type III spinal cord on preoperative apex MRI:preoperative traction does improve the safety of correction surgery

作　　者：刘万友 史本龙[2] 戴瑜彤 许彦劼 刘臻[2] 孙旭 朱泽章 邱勇 Liu Wanyou;Shi Benlong;Dai Yutong;Xu Yanjie;Liu Zhen;Sun Xu;Zhu Zezhang;Qiu Yong(Deportment of Spine Surgery,Nanjing Drum Tower Hospital,Clinical College of Xuzhou Medical University,Nanjing 210008,China;Division of Spine Surgery,Department of Orthopaedic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]徐州医科大学鼓楼临床学院骨科脊柱外科,南京210008 [2]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008

出　　处：《中华骨科杂志》2023年第6期359-365,共7页Chinese Journal of Orthopaedics

基　　金：南京市医学科技发展资金一般性课题(CZLB1480-202)

摘　　要：目的探讨Halo重力牵引对术前顶椎区脊髓形态分型为Ⅲ型的严重脊柱侧后凸畸形患者影像学的改善效果及手术安全性。方法回顾性分析2019年2月至2021年6月南京鼓楼医院收治术前脊髓形态分型为Ⅲ型的47例严重侧后凸畸形患者的病历资料,男18例、女29例;年龄(22.5±12.8)岁(范围9~60岁)。接受Ⅰ期Halo重力牵引、Ⅱ期脊柱后路矫形内固定术治疗,牵引时间为(7.4±3.9)周(范围4~16周)。影像学参数包括牵引前后及手术后即刻的侧凸Cobb角、冠状面平衡[C_(7)铅垂线至骶骨中垂线的距离(C_(7)plumb line and center sacral vertical line,C_(7)PL-CSVL)]、矢状面最大后凸Cobb角及矢状面平衡(sagittal vertical axis,SVA),计算牵引后矫正率和手术后矫正率。采用Frankel分级评估手术前后的神经功能状态。结果47例患者Halo重力牵引及矫形内固定手术均顺利完成。牵引前侧凸Cobb角为116.0°±17.5°,Halo重力牵引后改善至87.9°±16.5°(t=9.10,P<0.001),牵引后矫正率为22.4%±10.3%;手术后改善至69.1°±21.0°(t=15.19,P<0.001),手术后矫正率为41.3%±14.5%。牵引前C_(7)PL-CSVL为(35.7±16.9)mm,手术后改善至(22.0±13.7)mm(t=13.75,P<0.001),手术后矫正率为39.9%±15.5%。牵引前后凸Cobb角为110.9°±22.1°,Halo重力牵引后改善至84.1°±19.9°(t=8.84,P<0.001),牵引后矫正率为23.7%±8.9%;手术后改善至65.3°±19.3°(t=10.63,P<0.001),手术后矫正率为40.1%±20.7%。牵引前SVA为(43.8±19.5)mm,手术后改善至(21.1±14.9)mm(t=10.32,P<0.001),手术后矫正率为53.1%±27.0%。14例患者牵引前存在下肢神经损害症状,8例于Halo重力牵引后神经功能明显改善,3例患者于手术后神经功能改善,余3例治疗过程中神经功能无明显改善。所有患者Halo重力牵引及手术后均未出现原有神经损害加重或出现新发神经损害。结论术前顶椎区脊髓形态分型为Ⅲ型的严重脊柱侧后凸畸形患者术前行Halo重力牵引可有效矫正畸�Objective To analyze the radiographic improvements after Halo-gravity traction in severe kyphoscoliosis patientswith type III spinal cord on preoperative apex MRI,and to assess the clinical outcomes and surgical safety of Halo-gravity traction in this cohort.Methods A total of 47 severe thoracic kyphoscoliosis patients with type III spinal cord on preoperative apex MRI who underwent preoperative Halo-gravity traction followed by one-stage posterior spinal fusion from February 2019 to June 2021 in the Nanjing Drum Tower Hospital were retrospectively analyzed.There were 18 males and 29 females with an average age of 22.5±12.8 years(range,9-60 years).The average duration of traction was 7.4±3.9 weeks(range,4-16 weeks).Radiographic parameters were measured including the coronal Cobb angle,distance between C_(7)plumb line and center sacral vertical line(C_(7)PL-CSVL),sagittalglobal kyphosis(GK)and sagittal vertical axis(SVA)atpre-traction,post-traction and post-operation,respectively.The traction correction rate was measured as"traction degree before traction-traction degree after traction/traction degree before traction"and the surgical correction rate was represented as"traction degree before traction-postoperative degree/traction degree before traction".The Frankel scoring system was used for the evaluation of neurological status at pre-traction,post-traction and post-operation.Results All of 47 patients underwent the Halo-gravity traction and posterior spinal correction surgery.The C_(7)PL-CSVL was 35.7±16.9 mm at initial visit.At post-operation,C_(7)PL-CSVL was improved to 22.0±13.7 mm(t=13.75,P<0.001),and the improvement rate was 39.9%±15.5%.The GK was 110.9°±22.1°at initial visit,which was improved to 84.1°±19.9°(t=8.84,P<0.001)after Halo-gravity traction with an average correction of 23.7%±8.9%.At post-operation,GK was improved to 65.3°±19.3°(t=10.63,P<0.001),and the improvement rate were 40.1%±20.7%.The SVA was 43.8±19.5 mm at initial visit.At post-operation,SVA was improved to 21.1±14.9 mm(

关 键 词：脊髓压迫症 脊柱侧凸 脊柱后凸 牵引术 磁共振成像 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]