经畸形复合椎截骨治疗脊柱结核角状后凸畸形的临床疗效  

Clinical study of deformed complex vertebral osteotomy(DCVO)in the treatment of angular kyphosis of cured spinal tuberculosis

作　　者：张宏其[1] 唐明星[1] 肖力戈 高琪乐[1] 郭超峰[1] 刘少华[1] 王昱翔[1] 邓盎[1] 刘金洋[1] Zhang Hongqi;Tang Mingxing;Xiao Lige;Gao Qile;Guo Chaofeng;Liu Shaohua;Wang Yuxiang;Deng Ang;Liu Jinyang(Department of Spine Surgery and Orthopaedics,National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科脊柱外科,中南大学湘雅医院国家老年疾病临床医学研究中心,长沙410008

出　　处：《中华骨科杂志》2021年第12期744-754,共11页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81472145);湖南省重点研发计划项目(2017SK2062);湖南省自然科学基金面上项目(2018JJ6060)。

摘　　要：目的探讨经畸形复合椎截骨技术(deformed complex vertebral osteotomy,DCVO)治疗治愈型脊柱结核角状后凸畸形的可行性及其临床疗效。方法回顾性分析2007年1月至2019年1月收治并行手术治疗的治愈型脊柱结核角状后凸畸形患者33例,男18例,女15例;年龄(39.5±15.0)岁(范围9~78岁)。病变主要累及节段:胸段14例、胸腰段16例、腰段3例。33例患者采用两种不同的截骨治疗策略,20例采用DCVO技术治疗(DCVO组),13例采用后路全椎体切除术(posterior vertebra column resection,VCR)治疗(PVCR组)。DCVO技术将多个畸形融合的病椎定义为"病椎复合体",在病椎复合体内进行截骨,两截骨面交汇于病椎复合体前缘,形成截骨处的闭合铰链,完全闭合截骨区域使骨-骨融合。比较两组患者的术中出血量、手术时间及手术相关并发症。主要观察指标为胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、矢状面平衡(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)及节段后凸角。采用Frankle神经功能分级评估神经功能恢复情况。结果所有病例均获得随访,随访时间7~72个月。DCVO组手术出血量(1315.00±462.57)ml,手术时间(293.00±83.86)min,并发症发生率为1.5%;均明显低于PVCR治疗组(P<0.05)。DCVO组术前节段后凸角为96.80°±6.32°,术后为29.10°±6.96°,较术前平均矫正67.7°,矫正率为69.9%,手术前后差异有统计学意义(t=48.477,P<0.05)。DCVO组矢状位参数:术前TK为96.96°±29.13°,术后为37.15°±4.88°,末次随访为37.00°±3.89°,TK术后矫正59.81°,矫正率为61.7%;术前LL为66.70°±21.21°,术后为42.25°±5.53°,末次随访为41.90°±4.98°,手术前后及末次随访的差异有统计学意义(F=23.997,P<0.05)。两组患者术后及末次随访时矢状位参数、脊柱骨盆参数均较术前有明显改善,手术前后矢状面及脊柱骨盆各参数(Objective To evaluate the feasibility and clinical efficacy of deformed complex vertebral osteotomy(DCVO)technique on the treatment of angular kyphosis of cured spinal tuberculosis.Methods A retrospective study was performed on patients with angular kyphosis of cured spinal tuberculosis who underwent the DCVO technique or posterior vertebral column resection(PVCR)technique from Jan,2007 to Jan,2019.33 patients were included,18 males and 15 females,the average age was 39.5±15.0 years old(ranged 9-78 years old).The vertebral deformity in thoracic vertebrae 14 cases,thoracolumbar vertebrae 16 cases,and lumbar vertebrae 3 cases.20 cases underwent the DCVO technique,while 13 cases underwent PVCR technique.For DCVO group,the multiple malformed vertebrae were considered a malformed complex,and a larger range and angle wedge osteotomy was performed within the complex using the DCVO technique.PVCR technique would resect the whole deformed vertebrae,and subsequently brought the two separated spinal columns together with instruments and titanium mesh.The intro-operative blood loss,operating time and complications were recorded.The radiological measurements included preoperative and postoperative spinopelvic parameters,which including thoracic kyphosis(TK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS)and segmental kyphosis.The recovery of neurological function was evaluated by Frankle classification.Results All patients were followed up for 7-72 months.Comparing with the cases underwent PVCR technique,the DCVO group has a significantly lower blood loss(1315.00±462.57 ml),operating time(293.00±83.86 min)and complications rate(1.5%).At the time of preoperation,postoperation and last follow-up,the deformity angle of DCVO group was 96.80°±6.32°,29.10°±6.96°and 29.05°±6.49°,which gained an average 69.9%correction rate.The statistical analysis suggested that deformity angle was enormously corrected.And there was an insignificant difference between DCVO group and P

关 键 词：结核 脊柱 脊柱后凸 截骨术 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]