Ⅰ期三柱截骨矫形术治疗脊柱侧凸伴脊髓纵裂  

One-stage three-column osteotomy for the treatment of scoliosis with split spinal cord malformation

作　　者：王新浩 郑伟 陈建光[2] 苗吉显 李凤春[4] WANG Xin-hao;ZHENG Wei;CHEN Jian-guang;MIAO Ji-xian;LI Feng-chun(Nanshi Hospital of Nanyang City,Nanyang 473000,Henan,China)

机构地区：[1]南阳市南石医院,河南南阳473000 [2]南阳市第一人民医院,河南南阳473000 [3]河南省骨科医院,河南郑州450000 [4]洛阳正骨医院,河南洛阳471000

出　　处：《中国骨伤》2020年第2期131-135,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:分析Ⅰ期三柱截骨矫形术用于脊柱侧凸伴脊髓纵裂的有效性及安全性。方法:对2015年1月至2017年12月接受Ⅰ期三柱截骨矫形术治疗的41例脊柱侧凸伴脊髓纵裂患者进行回顾性分析,其中男17例,女24例;年龄(25.14±4.51)岁;体重(65.14±9.11)kg。根据脊髓纵裂的分型进行分组,15例PangⅠ型纵裂为A组,26例PangⅡ型纵裂为B组。记录两组患者的一般情况;观察两组患者手术前后的Cobb角并计算冠状面Cobb角矫正率;术后对两组患者冠状位与矢状位躯干偏移距离进行比较,评价其躯干平衡性;记录两组患者并发症发生情况。结果:术后41例患者均获得12个月以上的随访。A组手术时间、术中失血量、围手术期输血量分别(610.14±115.02)min、(4001.12±1014.33)ml、(3951.14±1021.55)ml,B组分别为(520.12±101.14)min、(2701.57±1021.45)ml、(2565.77±880.47)ml,两组差异有统计学意义(P<0.05);A、B两组术后住院时间分别为(9.45±4.21)d和(9.14±3.01)d,差异无统计学意义(P>0.05)。术后冠状面Cobb角及矫正率比较,两组差异无统计学意义(P>0.05);术后即刻、术后12个月,两组冠状位躯干偏移距离、矢状位躯干偏移距离比较,差异均无统计学意义(P>0.05);A组术后6例患者有并发症发生,高于B组的1例(χ^2=4.885,P<0.05)。结论:Ⅰ期三柱截骨矫形术用于脊柱侧凸伴脊髓纵裂的治疗,矫正率高,患者躯干稳定性好。但对于Ⅰ类纵裂患者而言,手术时间较长、术中失血量多,围术期需大量输血,且并发症风险高,安全性不及Ⅱ类患者,故在脊柱侧凸的实际治疗中,特别是对于伴Ⅰ类脊髓纵裂者,还应结合患者实际情况为其制定更为合理的手术方案,以提高手术安全性。Objective:To analyze the effectiveness and safety of one-stage three-column osteotomy in treatment of scoliosis with split spinal cord malformation.Methods:The clinical data of 41 patients with scoliosis and split spinal cord malformation underwent one-stage three-column osteotomy from January 2015 to December 2017 were retrospectively analyzed.There were 17 males and 24 females with average age of(25.14±4.51)years old and the average weight of(65.14±9.11)kg.According to the classification of longitudinal spina bifida,15 cases of Pang typeⅠwere group A and 26 cases of Pang typeⅡwere group B.The general situations of two groups were recorded;preoperative and postoperative Cobb angle were observed and the correction rate of Cobb angle of coronal plane was calculated;the coronal and sagittal torso offset distances were compared between two groups and the trunk balance was evaluated;the complication of two groups was recorded.Results:All 41 patients were followed up for more than 12 months.The operation time,intraoperative blood loss,and perioperative blood transfusion volume in group A were(610.14±115.02)min,(4001.12±1014.33)ml,(3951.14±1021.55)ml,respectively,and group B were(520.12±101.14)min,(2701.57±1021.45)ml,(2565.77±880.47)ml,the difference between the two groups was statistically significant(P<0.05).The postoperative hospital stays in the group A and B were(9.45±4.21)days and(9.14±3.01)days,respectively,and there was no significant difference(P>0.05).There was no significant difference in postoperative coronary Cobb angle and correction rate between two groups(P>0.05).Immediately after surgery and 12 months after surgery,there was no significant difference in the trunk displacement distance of coronal view and sagittal view between two groups(P>0.05).Six patients in group A had complications,which was higher than that in group B of 1 case(χ^2=4.885,P<0.05).Conclusion:One-stage three-column osteotomy in treatment of scoliosis with split spinal cord malformation has high correction rate and good

关 键 词：脊柱侧凸 脊髓纵裂 Ⅰ期三柱截骨术 COBB角 

分 类 号：R687[医药卫生—骨科学]