经椎间隙楔形截骨技术治疗脊柱侧后凸畸形  

Intervertebral wedge osteotomy to treat scoliosis and kyphosis

作　　者：姜超[1] 王欢[1] 范波[1] 崔少千[1] 阎崇楠[1] 金国鑫[1] 张磊[1] 

机构地区：[1]中国医科大学附属盛京医院脊柱外科,110000

出　　处：《中华骨科杂志》2017年第8期466-473,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨腰椎后路楔形截骨技术（intervertebral wedge osteotomy，IWO）治疗重度脊柱侧后凸畸形的可行性及临床疗效。方法回顾性分析2010年1月至2016年2月手术治疗38例重度脊柱侧后凸及脊柱后凸畸形患者的病例资料，男22例，女16例；年龄13—69岁，平均31岁。按截骨方式分为四组，即IWO组、Smith-Petersen截骨（Smith-Petersen oste-otomy，SPO）组、经椎弓根椎体截骨（pedicle subtraction osteotomy，PSO）组和全脊椎截骨（vertebral column resection，VCR）组，评价指标包括平均固定节段数、手术时间、出血量、术后住院时间、主弯Cobb角改善率、Oswestry功能残障指数Oswestry disability index，ODI）改善率及Frankel分级改善情况。结果四组患者手术时间的差异无统计学意义。SPO截骨组（18例）平均固定节段为（9．4±3．9）节，术中出血量（3000±410）ml，Cobb角改善率55．3％±9．5％，术后住院时间（14．9±4．9）d，ODI改善率42．1％±7．4％；4例术前Frankel分级D级患者术后均改善为E级，14例术前E级患者术后无变化。PSO截骨组（5例）平均固定节段为（7．6±1．5）节，术中出血量（4360±1161）ml，Cobb角改善率58．9％±15．1％，术后住院时间（18．2±7．0）d，ODI改善率41．3％±9．6％，1例术前C级术后改善为D级，4例E级术后无明显变化。VCR截骨组（4例）平均固定节段为（6．2±2．6）节，术中出血量（3750＋1848）ml，Cobb角改善率83．9％±10．9％，术后住院时间（21±7．2）d，ODI改善率39．6％±18．1％，1例术前C级患者术后改善为D级，3例术前D级患者术后均改善为E级。IWO组（11例）平均固定节段为（7．2±2．7）节，术中出血量（2855±1046）ml，Cobb角改善率59．6％±22．05％，术后住院时间（13．5±2．7）d，ODI改善率51．3％±8．3％；1例术前c级患者术后改善为D级，8例术前D级术后改善为E级，余2例术前E�Objective To compare the feasibility and efficacy of intervertebral wedge osteotomy and pedicle subtraction osteotomy （PSO）, vertebral column resection （VCR）, Smith-Petersen osteotomy （SPO）for the treatment of severe kyphosis and scoliosis. Methods The data of 38 cases of severe kyphosis and kyphoscoliosis were retrospectively analyzed from January 2010 to February 2016, including 22 males and 16 females. According to the osteotomy mode, PSO, SPO, VCR and intervertebral disc wedge osteotomy were used to collect the average number of fixed phases, volume of bleeding, length of stay, length of hospital stay, improvement of main cobb angle, improvement of ODI score, and Frankel classification to evaluate the efficacy. Results There were no significant differences in the overall operative time between the four groups. The average number of fixation in 18 patients with SPO was （9.4±3.9） segments, the blood loss was （3 000±410） ml, the average Cobb angle was improved by 55.3%± 9.5%, the average postoperative hospitalization was （14.6±4.9） days, the improvement rate of ODI was 42.1%±7.4%, all the patients were improved to Frankel E; The average number of fixation in 5 patients with PSO was （7.6±1.5） segments, the blood loss was （4 360± 1 161） ml, the average Cobb angle was improved by 58.9%± 15.1%, the average postoperative hospitalization was （18.2±7.0） days, the improvement rate of ODI was 41.3%±9.6%. One Frankel C patient was improved to Frankel D, others remained to be Frankel E as the same as pre-operation; The average number of fixation in 4 patients with VCR was （6.2±2.6） segments, the blood loss was （3 750＋ 1 848） ml, the average Cobb angle was improved by 83.9%±10.9%, the average postoperative hospitalization was （21 ±7.2） days, the improvement rate of ODI was 39.6%± 18.1%. Three Frankel D patients were improved to Frankel E and one Frankel C patient was improved to Frankel D; The average number of fixation in 11 patients with IWO was （7.1 ± 2.7

关 键 词：脊柱侧凸 脊柱后凸 截骨术 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]