伴发ChiariⅠ型畸形和脊髓空洞脊柱侧凸患者一期后路脊柱矫形术后5年以上随访结果  

The follow-up outcomes of more than 5 years after one-stage posterior correction of scoliosis with Chiari Ⅰ malformation and syringomyelia

作　　者：夏古尚 解京明[1] 王迎松[1] 赵智[1] 李韬[1] 毕尼[1] XIA Gushang;XIE Jingming;WANG Yingsong(Department of Orthopaedics,the 2nd Affiliated Hospital of Kunming Medical University,Kunming,650101,China)

机构地区：[1]昆明医科大学第二附属医院骨科,云南省昆明市650101

出　　处：《中国脊柱脊髓杂志》2021年第1期47-55,共9页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学基金(81360281、81960413);云南省科技厅-昆明医科大学联合专项基金[2017FE467(-064)]。

摘　　要：目的 :分析一期后路脊柱矫形术治疗伴发ChiariⅠ型畸形(ChiariⅠmalformation,CM1)和脊髓空洞(syringomyelia,SM)脊柱侧凸患者的5年以上随访结果。方法:2007年1月~2015年6月收治23例伴发CM1和SM的脊柱侧凸患者,男19例,女4例,年龄10~39岁(16.0±5.9岁)。均行一期后路脊柱矫形术,其中10例行后路全脊椎截骨矫形术(posterior vertebral column resection,PVCR),13例行单纯脊柱矫形而未行短缩截骨术。所有患者手术前后和随访时行全脊柱X线片、CT及MRI检查,在全脊柱X线片上评价患者的矢状位和冠状位矫形率,在MRI上测量SM的大小及变化。根据MRI结果,取颈脊髓空洞张力指数(cervical syrinx tension ratio,CSTR)平均值作为描述颈段SM大小及变化的指标,将末次随访时CSTR下降≥20%定义为SM改善,并将患者分为颈段SM改善组和无改善组;再根据术中是否行脊柱短缩截骨术,将患者分为PVCR组和非PVCR组。记录患者性别、手术年龄、顶椎节段、冠状位主弯角度、矢状位后凸角度、畸形角度比(deformity angular ratio,DAR)、SM长度、平均CSTR、术前牵引情况、融合节段数量、末次随访时冠状面矫形率与矢状面矫形率、SM改善情况、随访时间等,并进行统计学分析。两组间定量变量的差异采用独立样本t检验的方法进行比较,定性变量差异采用χ2检验。结果:随访时间为6.2±1.1年(5~9年)。术前冠状位主弯角度为77.1°±28.0°(33°~122°),术后减少至27.8°±18.4°,末次随访时为29.5°±21.2°,冠状面侧凸矫正率为(65.7±13.0)%。术前矢状面后凸角度为57.2°±31.9°(8°~155°),术后减少至29.3°±15.2°,末次随访时为32.4°±16.5°,矢状面后凸矫正率为(48.4±22.6)%。所有病例未见内固定螺钉松动、断裂,骨性融合均良好,无术后神经功能损害。CSTR改善率为47.8%(11/23),SM改善组11例,SM无改善组12例。SM改善组患者的平均手术年龄(18.6±7.5岁vs. 13.7±2.4岁,P=0.040)、接受PVCRObjectives: To analyze the more than 5 years′ follow-up outcomes of scoliosis with Chiari Ⅰmalformation(CM1) and syringomyelia(SM) treated by one-stage spinal correction. Methods: A retrospective study was performed on 23 patients with CM1 and SM associated scoliosis treated from January 2007 to June2015. The patients had complete clinical data and were followed up for more than 5 years after one-stage spinal correction. There were 19 males and 4 females with an average age of 16.0 ±5.9(range, 10-39) years old. The one-stage spinal correction was performed on all the patients, including 10 patients with posterior vertebral column resection(PVCR), 13 patients with simple spinal correction without shortening osteotomy. The spinal radiographs were obtained from all patients preoperatively, postoperatively and at final follow-up. Syringomyelia size and change were measured based on the results of MRI. According to full-spine standing radiographs, the spine sagittal and coronal correction rate were evaluated. According to the results of MRI, the average cervical syrinx tension ratio(CSTR) was used as an indicator of syrinx size and change, and a ≥20%decline was set as a boundary of syrinx improvement at the final follow-up. According to the degree of CSTR decline, all the cases were divided into two groups: with or without cervical SM improvement. And the cases were also divided into with or without PVCR based on whether the spinal shortening osteotomy was performed intraoperatively. Then gender, age at surgery, apical level, main scoliosis, kyphosis, deformity angular ratio(DAR), length of syrinx, average CSTR, preop traction, No. of fusion segments, coronal correction rate, sagittal correction rate, syrinx improvement, and period of the follow-up were compared separately. Differences between two groups were assessed by independent t test, and categorical variables were compared using Chisquare test. Results: The average follow-up period of all patients was 6.2 ±1.1 years(range, 5-9 years). The average scolio

关 键 词：脊柱侧凸 Chiari畸形 脊髓空洞 外科矫形 随访结果 

分 类 号：K682.3[历史地理—历史学] K687.3[历史地理—世界史]