隧道成型技术在经椎弓根椎体截骨术的临床应用  

Clinical application of Tunnel-Plasty on modified pedicle subtraction osteotomy

作　　者：赵亮[1] 陈书连[2] 高延征[2] 张锴 曹臣[2] 纪海续 邢帅[2] Zhao Liang;Chen Shulian;Gao Yanzheng;Zhang Kai;Cao Chen;Ji Haixu;Xing Shuai(Department of Orthopaedics, First People's Hospital of Zhengzhou City, Zhengzhou 450001, China;Department of Orthopaedics, People's Hospital Henan Province, Zhengzhou 450003, China;Sanquan College of Xinxiang Medical College, Xinxiang 45003, China)

机构地区：[1]郑州市第一人民医院骨科,450001 [2]河南省人民医院脊柱脊髓科,郑州450003 [3]新乡医学院三全学院,453003

出　　处：《中华骨科杂志》2019年第18期1125-1132,共8页Chinese Journal of Orthopaedics

基　　金：河南省医学科技重点攻关项目(201502024);河南省科技厅基础与前沿项目(1221102310145).

摘　　要：目的总结隧道成型法经椎弓根椎体截骨(pedicle subtraction osteotomy,PSO)的技术要点,并探讨其临床效果及相关并发症。方法收集2012年6月至2017年6月共41例胸腰段陈旧性椎体骨折患者资料,男19例,女22例;年龄37~67岁,平均(60.1±12.7)岁。致伤原因:外伤后非手术治疗15例,手术后失败13例,骨质疏松症13例。损伤节段:T11节段9例、T12 22例、L1 8例、L22例。根据随机数字法将患者分为传统PSO治疗组(传统组,21例)和改良PSO治疗组(改良组,20例)。传统组术中采用"蛋壳"技术,改良组术中采用隧道成型技术,将手术分成显露、置钉与后柱复合体的切除、椎体截骨、矫形与植骨共四个步骤。组间对比各步骤的操作时间、出血量及并发症情况。采用疼痛视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数问卷(Oswestry disability index,ODI)表评价临床疗效,测量脊柱Cobb角评价后凸畸形矫正情况。结果41例均获随访,时间12~24个月。传统组总手术时间(273.3±21.1)min,改良组(178.1±12.5)min,差异有统计学意义(t=8.981,P=0.019);置钉与后柱复合体的切除、椎体截骨手术时间的组间比较,差异均有统计学意义(t置钉= 4.614,P置钉=0.036;t截骨=9.089,P截骨=0.020)。传统组总出血量(1540.3±38.3)ml,改良组(754.4±104.2)ml,差异有统计学意义(t=8.529,P=0.011)。置钉与后柱复合体的切除、椎体截骨出血量组间分别对比差异均有统计学意义(t置钉= 11.933,P置钉=0.016;t截骨= 6.972,P截骨=0.013)。传统组术前、术后1周及术后半年Cobb角分别为40.2°±8.9°、12.5°±6.8°和10.4°±2.5°,改良组为39.5°±6.3°、10.4°±3.5°和9.5°±1.9°,组内对比差异有统计学意义(F改良组=189.573,P改良组=0.021;F传统组=194.699,P传统组=0.029)。截骨区骨性融合时间3~6个月,平均4.8个月。传统组术后半年VAS评分和ODI分别为(2.1±0.3)分和(34.1±4.3)分,改良组为(2.2±1.1)分和(28.3±6.8)分,差Objective To summarize the technical points and clinical efficacy of pedicle subtraction osteotomy (PSO) in tunneling and to explore the related complications of this technique. Methods A total of 67 cases of old vertebral fractures of the thoracolumbar region from June 2012 to June 2017 were collected. According to the inclusion and exclusion criteria, a total of 41 cases were included in the study. There were 19 males and 22 females;aged 37-67 years, mean 60.1±12.7 years;15 cases of non-surgical treatment after trauma, 13 cases of failure after surgery and 13 cases of osteoporosis. Injury segment: 9 cases of T11, 22 cases of T12, 8 cases of L1, 2 cases of LS. Preoperative patients were diagnosed by X-ray, CT plain and 3D reconstruction combined with MRI. There were 23 cases of intractable back pain, 16 cases of lower extremity root pain, and 2 cases of intermittent claudication. Patients were divided into the traditional PSO treatment group (21 cases) and modified PSO treatment group (20 persons) according to the random number method. The traditional group were treated with the "egg shell" technique, and the improved group were treated with tunnel forming technology. The procedure was divided into four steps: exposure (step 1), nail placement and resection of the posterior column complex (step 2), vertebral osteotomy (step 3), orthopedics and bone grafting (step 4). The operation time, bleeding volume and complications of each step were compared between the two groups. The clinical efficacy was evaluated using the visual analogue scale (VAS) score and the Oswestry disability index (ODI). The X-ray spine Cobb angle was measured to evaluate the Keloid deformity correction, and the bone graft fusion was observed by CT examination. Results All patients were followed up for 12 to 24 months. The total operation time of the traditional group was 273.3±21.1 min, and the total operation time of the modified group was 178.1±12.5 min, the difference between the two groups was statistically significant (t=8.981, P=0.001

关 键 词：截骨术 矫形外科手术 脊柱骨折 

分 类 号：R687.3[医药卫生—骨科学]