近端经皮固定联合远端开放截骨治疗成人脊柱畸形合并矢状面失平衡  

The efficacy of proximal percutaneous pedicle screw fixation combined with distal open osteotomy for sagittal plane imblance of adult spinal deformity

作　　者：胡旭栋[1] 陈云琳[1] 蒋伟宇[1] 阮超越 马维虎[1] 

机构地区：[1]宁波市第六医院脊柱外科,315040

出　　处：《中华骨科杂志》2017年第8期474-479,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨近端经皮椎弓根螺钉固定联合远端开放截骨治疗成人脊柱畸形合并矢状面失平衡的近期疗效。方法回顾性分析2011年1月至2015年6月23例接受手术治疗的成人脊柱畸形合并矢状面失平衡患者病例资料，男7例，女16例；年龄52-67岁，平均62．1岁。均采用近端经皮椎弓根螺钉固定联合远端开放截骨矫形融合术，记录手术时间、术中出血量、术后引流量及围手术期并发症发生情况。手术前后均摄站立位全脊柱正、侧位X线片，测量矢状面躯干偏移（sagittal vertical axis，SVA）、腰椎前凸角（1umbar lordosis，LL）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，ss）、骨盆投射角与腰椎前凸角差值（pelvic incidence／lumbar lordosis mismatch，PI-LL），对比分析手术前后以上参数变化。术前及末次随访时采用Oswestu功能障碍指数（Oswestry disability index，ODI）评价临床疗效。结果23例患者手术时间220-310min，平均（253．9±52．1）min；术中出血量1050-2360ml，平均（1258．5±272．2）ml；术后引流量580-960ml，平均（725．1±135．2）ml。围手术期无一例发生感染、深静脉血栓形成及死亡等并发症。23例患者均获得随访，随访时间13-52个月，平均21．2个月。SVA由术前（12．6±1．4）cm矫正至术后（3．5±0．7）cm，LL由术前13．5°±2．3°矫正至术后38．8°±9．6°，SS由术前13．90±2．30矫正至术后25．5°±5．8°、PT由术前29．7°±9．6°矫正至术后18．9°±8．2°，PI-LL由术前29．5°±13．7°矫正至术后7．1°±3．6°；以上各指标手术前后比较，差异均有统计学意义。ODI由术前的40．3％±12．5％降至末次随访时13．6％±2．57％，差异有统计学意义。结论近端经皮椎弓根螺钉固定联合远端开放截骨矫形融合术能有效重建成人脊柱畸形矢状面平衡，提高患者生活质量。Objective To evaluate the efficacy of proximal pereutaneous pediele screw fixation combined with distal open osteotomy for sagittal plane imbalance of adult spinal deformity. Methods From January 2011 to June 2015, 23 patients with diagnosis of adult spinal deformity were treated with proximal percutaneous pedicle screw fixation combined with distal open osteotomy, there were 8 males and 15 females, aged from 52 to 67 years old （average, 62.1 years old）. The operation time, blood loss, drainage and per[operative complications were recorded; standing anteroposterior and lateral radiographs of the whole spine were taken and the following parameters were measured： sagittal vertical axis （SVA）, lumbar lordosis（LL）, pelvic tilt （PT）, sacral slope （SS）, pelvic incidence/lumbar lordosis mismatch （PI-LL）, the above parameters were compared between preoperation and postoperation. Oswestry disability index （ODI） was used to evaluate the clinical efficacy. Results The mean operation time was 253.9±52.1 min, the mean blood loss and drainage was 1 258.5±272.2 ml and 725.1±135.2 ml. No patient got infected, died or had deep vein thrombosis. All patients were followed up for an average of 21.2 months （range, 13-52 m）. The SVA was restored from 12.6±1.4 cm to 3.5±0.7 era. In addition, LL, SS, PT, and PL-LL were improved from 13.5°±2.3°, 13.9°±2.3°, 29.7°±9.6°, 29.5°±13.7° to 38.8°±9.6°, 25.50±5.8°, 18.9°±8.2°, 7.1°±3.6°. The ODI score decreased from 40.3%±12.5% to 13.6%±2.57% at the time of the last follow-up compared with preoperation. Conclusion Proximal percutaneous pedicle screw fixation combined with distal open osteotomy for sagittal plane imbalance of adult spinal deformity could restore the sagittal balance and improve the quality of life.

关 键 词：成年人 脊柱弯曲 截骨术 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]