退变性腰椎侧凸的冠状面失衡分型及对截骨矫形术式选择的意义  

Classification of coronal trunk imbalance in degenerative lumbar scoliosis and its influence on osteotomy strategy

作　　者：邱勇[1] 王斌[1] 朱锋[1] 朱泽章[1] 俞杨[1] 钱邦平[1] 孙旭[1] 马薇薇[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2009年第5期418-423,共6页Chinese Journal of Orthopaedics

基　　金：基金项目：江苏省人事厅六大人才高峰项目（07-B-027）

摘　　要：目的探讨退变性腰椎侧凸冠状面躯干失衡的分型及对截骨矫形术式选择的意义。方法统计自2000年10月至2006年10月期间收治的退变性腰椎侧凸患者36例，均接受后路三维内固定截骨矫形术，男13例，女23例。年龄49-73岁，平均60．1岁。术前Cobb角33°-86°，平均48.3°。术前根据站立位全脊柱正位X线片冠状面失衡情况将患者分为3型：A型，C7铅垂线（C7 plumb line，CTPL）偏距骶骨中垂线（center sacral vertical line，CSVL）〈3cm；B型，C7PL偏向腰椎主弯凹侧〉3cm；C型，C7PL偏向腰椎主弯凸侧〉3cm。结果本组患者随访12个月～5年，平均28个月。根据分型标准，A型10例，B型20例，C型6例。手术策略根据分型选择，A型和B型采用单纯后路顶椎区凸侧入路截骨矫形术，术后Cobb角平均22°，矫正率平均为58％；C型采用后路矫形，后路截骨水平在主弯远端，术后Cobb角平均26°，矫正率平均为40％。两种截骨术后患者冠状面平衡均恢复良好，术后A、B、C3组C，PL与CSVL的平均距离分别为0．6cm、1．0cm和1．2cm，随访时矫正无明显丢失。无死亡，无感染等并发症。结论冠状面失衡分型系统基于退变性腰椎侧凸冠状面失衡情况而设定，以此分型为依据有针对性选择不同截骨矫形策略可以使术后躯干平衡恢复更具预测性。Objective To propose a classification system of degenerative lumbar scoliosis based on frontal trunk imbalance and to investigate the correction outcomes following the osteotomy strategy according to this system. Methods From October 2000 to October 2006, thirty-six patients with degenerative lumbar scoliosis were treated in our hospital. It included 13 males and 23 females with a mean age of 60.1 years （ranged 49-73 years）. Based on the pre-operative posteroanterior standing X-ray films, all patients were classified according to frontal truncal balance （the distance between C7 plumb line to center sacral vertical line）： Type A, the distance between C7 plumb line and central sacral vertical line is less than 3 cm; Type B, C7 plumb line shifts more than 3 cm to the concave side of the lumbar curve; and Type C, C7 plumb line shifts more than 3 cm to the convex side. Results All patients received posterior 3-D instrumentation correction with osteotomy and were followed up for 28 months （ranged 12-60 months）. According to the classification system, there were 10 cases with Type A, 20 cases with Type B, 6 cases with Type C. For patients with Type A and Type B, the osteotomies were performed from convex side and the post-operative average angle were 22° （correction rate of 58%）. For patients with Type C curve, the osteotomies were performed from distal end area of concave side and the post-operative average angle were 26° （correction rate of 40%）. The average distance between C7 plumb line and center vertical sacral line was 0.6 cm, 1.0 cm and 1.2 cm, respectively. There was no significant loss of correction in all types and no death and infection occurred during the follow- ups. Conclusion This classification system for degenerative lumbar seoliosis was established on the basis of frontal trunk imbalance. According to this system, options of the osteotomy level and the osteotomy approach could be decided with satisfactory outcomes.

关 键 词：脊柱侧凸 截骨术 治疗结果 

分 类 号：R686[医药卫生—骨科学]