伴骶骨发育不良的先天性腰骶部畸形远端固定到S1的可行性分析  

The feasibility analysis of distal anchor at S1 for congenital lumbosacral deformities associated with sacral agenesis

作　　者：张天元 鲍虹达 刘臻[1] 孙旭[1] 俞扬[1] 王斌[1] 钱邦平[1] 邱勇[1] 朱泽章[1] ZHANG Tianyuan;BAO Hongda;LIU Zhen(Department of Spine Surgery,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing,210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,南京市210008

出　　处：《中国脊柱脊髓杂志》2019年第12期1065-1070,共6页Chinese Journal of Spine and Spinal Cord

基　　金：江苏省自然科学基金(BK20180122);南京市卫生科技发展专项资金项目(YKK18092)。

摘　　要：目的:分析伴骶骨发育不良的先天性腰骶部畸形患者手术矫形效果以及随访中冠状面平衡的变化情况,探讨远端固定至S1的可行性。方法:回顾性分析2009年1月~2018年1月在我科接受手术矫形且远端固定至S1的先天性腰骶部畸形合并骶骨发育不良的患者,分别于术前、术后即刻和末次随访时的站立位全脊柱正侧位X线片上测量腰椎侧凸Cobb角、冠状面平衡距离(CBD)和骨盆倾斜角(POA),将术后CBD>2cm定义为冠状面失平衡,观察冠状面平衡在术后的转归。结果:共有6例患者纳入本研究,男女各3例,年龄4.11±1.57岁(3~6岁),随访时间为3.83±1.47年(1~6年)。患者术前腰椎侧凸Cobb角为39.20°±6.27°,术后为16.53°±14.16°,差异有统计学意义(P<0.05),末次随访时为22.48°±9.80°,矫正效果维持良好。术前和术后即刻CBD分别为18.30±16.85mm和22.47±8.77mm,末次随访时CBD已进展为31.35±8.61mm,冠状面平衡无明显改善(P>0.05),反而出现了加重趋势,5例表现为术后冠状面失平衡,发生率高达83.3%(5/6)。术后和末次随访时的POA与术前比较均无统计学差异(P>0.05)。结论:对于伴骶骨发育不良的先天性腰骶部畸形患者,矫形手术远端固定到S1虽能即刻纠正侧凸畸形,但术后容易出现冠状面平衡的失代偿问题,可考虑通过骨盆固定来解决这一问题。Objectives:To analyse the surgical outcome and condition of coronal balance for congenital lum-bosacral deformities combined with sacral agenesis and evaluate the feasibility of distal anchor at S1.Methods:Six patients diagnosed with congenital lumbosacral deformities combined with sacral agenesis receiving surgical treatment with distal anchor at S1 from January 2009 to January 2018 were reviewed retrospectively.Lumbar Cobb angle,coronal balance distance(CBD)and pelvic obliquity angle(POA)were measured at base-line,immediate post-operation and follow-up in the long-cassette standing posteroanterior and lateral radio-graphs of the entire spine.Results:Six patients(3 boys and 3 girls)were recruited in our study with an average follow-up period of 3.83±1.47 years(1-6 years).The average age was 4.11±1.57 years(3-6 years).The lumbar Cobb angel was 39.20°±6.27°before surgery,16.53°±14.16°after surgery and 22.48°±9.80°at the last follow-up,with significant difference(P<0.05).However,the coronal balance had a tendency of deterioration.The preoperative and immediate postoperative CBD were 18.30±16.85 mm and 22.47±8.77 mm,respectively.But it increased to 31.35±8.61 mm at the last follow-up.If CBD>2 cm was defined as coronal imbalance,5 cases presented postoperative coronal imbalance with a high incidence of 83.3%.Compared with preoperation,postoperative and follow-up POA showed no significant difference(P>0.05).Conclusions:For congenital lumbosacral deformities combined with sacral agenesis,although distal anchor at S1 may immediately correct the deformity,coronal imbalance is prone to occur postoperatively.Therefore,pelvic fixation may be a better choice to avoid these problems.

关 键 词：腰骶部畸形 骶骨发育不良 冠状面失平衡 躯干倾斜 

分 类 号：R682.1[医药卫生—骨科学] R687.3[医药卫生—外科学]