后路脊柱截骨术与牵引辅助后路广泛松解术治疗重度脊柱畸形的比较研究  

A comparison of posterior spinal osteotomy versus Halo traction with wide posterior release for severe spinal deformity

作　　者：王华锋[1] 刘辉[1] 郑召民[1] 梁春祥[1] 王建儒[1] 王华[1] 李泽民[1] 叶福标[1] 李思贝 潘鹤海[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州510080

出　　处：《中国骨与关节杂志》2014年第12期896-900,共5页Chinese Journal of Bone and Joint

摘　　要：目的比较后路脊柱截骨术和牵引辅助后路广泛松解术治疗重度脊柱畸形的围手术期并发症和初步疗效。方法回顾性比较研究我科收治的29例重度脊柱畸形患者资料。2013年8月至2014年6月,行牵引辅助后路广泛松解术矫形患者(牵引组)12例;2012年6月至2013年8月,行后路脊柱截骨手术矫形患者(对照组)17例。牵引组术前主弯Cobb's角平均为111.8°,对照组平均为115.2°;牵引组术前最大后凸角度平均为113.3°,对照组为118.5°。比较两组间术后90天内的并发症发生率以及临床疗效。结果两组术前平均年龄、性别比、体重指数、主弯角度、主弯柔韧度、最大后凸角差异无统计学意义。手术时间,牵引组和对照组分别为(322.1±102.5)min和(426.3±100.4)min(P=0.012);术中出血量,牵引组和对照组分别为(1241.7±999.5)ml和(2300.0±1449.1)ml(P=0.040);置钉密度,牵引组和对照组分别为(58.0±16.2)%和(77.4±13.1)%(P=0.001);而围手术期并发症,牵引组和对照组分别为16.7%和58.8%(P=0.049);两组比较,牵引组显著小于对照组,差异有统计学意义,但两组的畸形矫正率相当。结论重度脊柱畸形患者的后路脊柱截骨术和牵引辅助后路广泛松解术,疗效相当,但牵引辅助后路广泛松解术,可避免侵袭性大的操作、缩短手术时间、减少出血量,并显著减少了围手术期并发症的发生率。Objective To compare the perioperative complications and clinical outcomes of posterior spinal osteotomy and Halo traction with wide posterior release for severe spinal deformity. Methods Records of 29 patients with severe spinal deformity treated in our hospital were examined. Twelve were treated by wide posterior release with traction from August 2013 to June 2014（Traction Group）, and 17 were treated with posterior spinal osteotomy from June 2012 to August 2013（Control Group ）. The average preoperative main curve for Traction Group was 111.8° and for Control Group was 115.2°. The average preoperative maximal kyphosis for Traction Group was 113.3° and for Control Group was 118.5°. Radiographic and clinical outcomes were compared between groups. Results A t test demonstrated that the differences between the groups in age, sex, body mass index（BMI）, preoperative main curve and maximal kyphosis, and preoperative main curve lfexibility were not statistically signiifcant. The postoperative deformity correction was comparable, however, the Traction Group had a statistically significant decrease in operative time [（322.1±102.5 ） min vs.（426.3±100.4 ） min, P=0.012 ], blood loss [（1241.7±999.5 ） ml vs.（2300.0±1449.1 ） ml, P=0.040 ], implant density [（58.0±16.2 ）%vs.（77.4±13.1 ）%, P=0.001 ] and total complication rate（16.7%vs. 58.8%, P=0.049 ）. Conclusions Study shows that effects of posterior spinal osteotomy and Halo traction with wide posterior release for severe spinal deformity are similar. However, Halo traction with wide posterior release can avoid aggressive procedures, reduce operation time, blood loss, and perioperative complications.

关 键 词：脊柱弯曲 脊柱侧凸 牵引术 矫形外科手术 截骨术 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]