休门氏病后凸畸形后路矫形融合术中远端固定椎的选择策略  

Selection of the distal fusion level in posterior spinal fusion for Scheuermann kyphosis

作　　者：许彦劼 胡宗杉 马鸿儒 钱至恺 阿布都哈卡尔·克拉木 汤子洋 凌宸 李韦彪 刘臻[1,2] 朱泽章[1,2] 邱勇[1,2] Xu Yanjie;Hu Zongshan;Ma Hongru;Qian Zhikai;Abdukahar·Kiram;Tang Ziyang;Ling Chen;Li Weibiao;Liu Zhen;Zhu Zezhang;Qiu Yong(Departement of Spine Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Spine Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,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,210008 [2]南京医科大学鼓楼临床医学院脊柱外科,210008

出　　处：《中华骨科杂志》2021年第13期834-843,共10页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82072518);十三五南京市卫生人才培养工程(QRX17126)。

摘　　要：目的比较休门氏病后凸畸形行后路矫形融合术中选择不同远端固定椎(lowest instrumented vertebra,LIV)的临床疗效及其并发症情况。方法回顾性分析2012年1月至2017年12月行后路矫形融合术治疗34例休门氏病脊柱后凸畸形患者的病历资料,男29例,女5例;年龄(17.1±4.3)岁(范围12~30岁)。所有患者随访时间均超过2年。根据远端固定椎选择的节段分为矢状面稳定椎(sagittal stable vertebra,SSV)组,即LIV位于SSV,共22例;SSV-1组,即LIV位于SSV上方椎体,共12例。影像学评价指标包括最大后凸Cobb角(global kyphosis,GK)、腰椎前凸角(lumbar lordosis,LL)、矢状面平衡(sagittalverticalaxis,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)。临床疗效评价采用脊柱侧凸研究学会-22简明量表调查问卷(Scoliosis Research Society questionnaires-22,SRS-22)。记录患者术中及术后随访期间的并发症发生情况。比较两组间矢状面形态的影像学参数及术后远端交界性后凸(distal junctional kyphosis,DJK)的发生率。结果两组患者在年龄、性别、术前影像学参数及SRS-22的差异均无统计学意义(P>0.05)。SSV组与SSV-1组患者术后GK矫正率分别为42.8%±7.6%和43.2%±8.4%(t=0.151,P=0.881),末次随访时GK矫正丢失率分别为1.2%±5.2%和3.9%±7.2%(t=0.767,P=0.449)。其余影像学参数在术后及末次随访时组间的差异均无统计学意义(P>0.05)。末次随访时SSV-1组患者的SRS-22功能维度为(4.1±0.6)分,明显高于SSV组的(3.7±0.5)分,差异有统计学意义(t=2.300,P=0.028),余各维度的差异均无统计学意义(P>0.05)。随访期间SSV组3例(13.6%)患者发生DJK,SSV-1组2例(16.7%)发生DJK,两组DJK发生率的差异无统计学意义(χ2=0.057,P=0.812)。结论对于休门氏病脊柱后凸畸形患者,与远端融合至SSV相比,固定至SSV-1可在保留腰椎活动度的同时获得相似的矢状面矫形效果,提升患者术后的生Objective To investigate the clinical outcomes and complication of posterior surgery for Scheuermann kyphosis fusing to different distal fusion levels.Methods From January 2012 to December 2017,a consecutive cohort of 34 patients who were treated with posterior spinal instrumented correction and satisfied the inclusion criteria were retrospectively reviewed,including 29 males and 5 females,aged 17.1±4.3 years(range,12-30 years).All of the patients had a minimum follow-up of 2 years.According to the distal fusion level,patients were divided into 2 groups.Group sagittal stable vertebra(SSV)(22 cases)included patients whose lowest instrumented vertebra(LIV)was SSV;Group SSV-1(12 cases)included patients who had a LIV one level above the SSV.Radiographic parameters including global kyphosis(GK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),and sacral slope(SS)were measured in the standing radiographs before and after operation and at the latest follow up.Intraoperative and postoperative complications were recorded.The Scoliosis Research Society-22 questionnaire(SRS-22)were conducted at pre-operation and the final follow up to evaluate the clinical outcomes.The sagittal radiographic parameters and the incidence of distal junctional kyphosis(DJK)were compared between the two groups.Results There were no significant differences in terms of age,sex,radiographic measurements and scores of SRS-22 between two groups preoperatively(P>0.05).The correction rates of GK in the SSV group and the SSV-1 group were 42.8%±7.6%and 43.2%±8.4%(t=0.151,P=0.881)respectively.While the correction rates loss were 1.2%±5.2%and 3.9%±7.2%(t=0.767,P=0.449)at the latest follow up.No significant difference was observed in terms of other radiographic parameters(P>0.05).During the postoperative follow up period,3 patients(16.7%)in SSV group and 2 patients(13.6%)in SSV-1 group developed DJK.The incidence of DJK did not show any significant difference between two groups(χ2=0.057,P=0.812).At the final follow-

关 键 词：SCHEUERMANN病 脊柱融合术 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]