计算机导航辅助置钉与截骨治疗上胸段后凸畸形  

Computer navigation-assisted surgical treatment with osteotomy for upper thoracic kyphosis

作　　者：何达[1] 李祖昌 赵经纬[1] 田伟[1] He Da;Li Zuchang;Zhao Jingwei;Tian Wei(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing100035,China)

机构地区：[1]北京积水潭医院脊柱外科北京大学第四临床医学院

出　　处：《中国组织工程研究》2020年第12期1859-1863,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家临床重点专科建设项目，项目负责人：北京积水潭医院;北京市医院管理局“使命”人才计划项目(SML20150401)，项目负责人：田伟~~

摘　　要：背景:上胸椎后凸畸形的生物力学特点较为独特,减压和内固定相对困难,既往相关的研究及病例报道较少,并且缺少计算机导航辅助下进行上胸段后凸畸形矫正的相关研究。目的:探究计算机导航辅助置钉与截骨治疗上胸段后凸畸形的临床疗效。方法:纳入2011年6月至2018年6月北京积水潭医院收治的T1-T4后凸畸形患者18例,其中男11例,女7例,年龄12-59岁,均进行计算机导航辅助置钉与PSO截骨治疗,术后随访检测后凸节段局部Cobb角,评估颈背部目测类比评分、颈椎脊髓功能Nurick评分、欧洲脊髓病EMS评分与患者手术整体满意度。试验通过北京积水潭医院伦理委员会批准,伦理批件号:积伦科审字第201709-23号。结果与结论:①18例患者均完成术后随访,随访时间6-90个月,平均(33.73±35.33)个月;②18例患者末次随访的局部Cobb角较术前明显改善[(47.32±9.92)°,(24.01±7.64)°,P<0.001],末次随访的目测类比评分较术前明显降低(3.64±2.16,0.73±1.01,P<0.001),末次随访的Nurick评分较术前明显降低(2.91±0.94,0.82±1.47,P<0.001),末次随访的EMS评分较术前明显升高(14.45±0.93,17.09±1.45,P<0.001);③患者手术满意度为优(16例)或良(2例);④至末次随访时,18例患者均未发生与植入物相关的不良反应,伤口愈合良好,未出现螺钉松动等问题;⑤结果表明,使用计算机导航辅助置钉与截骨定位进行合理的截骨矫形,可以使上胸段后凸畸形获得有效治疗。BACKGROUND:The biomechanical characteristics of kyphosis of the upper thoracic vertebra are unique.Decompression and internal fixation are relatively difficult.Previous relevant studies and case reports are few,and there is a lack of research on correction of kyphosis of the upper thoracic section with the assistance of computer navigation.OBJECTIVE:To explore the clinical effect of computer navigation-assisted surgical treatment of upper thoracic kyphosis by screws and osteotomy.METHODS:Totally 18 patients with kyphotic deformity of the spine(T1-T4)were admitted in Beijing Jishuitan Hospital from June 2011 to June 2018,including 11 males and 7 females,aged 12 to 59 years.They were all treated with computer-assisted surgical treatment with PSO osteotomy.Local Cobb angle of the upper thoracic kyphosis was determined during final follow-up.Cervical visual analogue scale,Nurick grades,EMS scores and satisfaction of the surgery were evaluated.This study was approved by the Ethics Committee of Beijing Jishuitan Hospital(approval No.201709-23).RESULTS AND CONCLUSION:(1)A total of 18 patients were followed up for 6-90 months at an average time of(33.73±35.33)months.(2)The local Cobb angle of 18 patients at the last follow-up was significantly improved[(47.32±9.92)°,(24.01±7.64)°,P<0.001].Cervical visual analogue scale score at the last follow-up was significantly lower than that before surgery(3.64±2.16,0.73±1.01,P<0.001).Nurick score at the last follow-up was significantly lower than that before surgery(2.91±0.94,0.82±1.47,P<0.001).EMS score at the last follow-up was significantly higher than that before surgery(14.45±0.93),17.09±1.45,P<0.001).(3)Surgical satisfaction was excellent(n=16)or good(n=2).(4)At the last follow-up,18 patients had no adverse reactions related to implants,and the wound healed well without screw loosening.(5)The results showed that reasonable osteotomy correction with computer-assisted surgery and PSO osteotomy could effectively treat kyphosis of upper thoracic segment.

关 键 词：上胸段 后凸畸形 PSO截骨矫形 计算机导航辅助 椎弓根螺钉内固定 功能 满意度 COBB角 

分 类 号：R68[医药卫生—骨科学] R318[医药卫生—外科学]