应用脊柱后柱截骨术治疗类"Lenke 5型"腰椎先天性脊柱侧凸  

Posterior column osteotomy for the treatment of "Lenke 5-like" lumbar congenital scoliosis

作　　者：潘玺宇 乔军[2] 刘臻[2] 毛赛虎[2] 孙旭[2] 朱泽章[1,2] 邱勇[1,2] Pan Xiyu;Qiao Jun;Liu Zhen;Mao Saihu;Sun Xu;Zhu Zezhang;Qiu Yong(Department of Spine Surgery,Nanjing Drum Tower Hospital,Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Spine Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院脊柱外科,210008 [2]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2021年第22期1598-1606,共9页Chinese Journal of Orthopaedics

基　　金：江苏省临床医学中心(YXZXA2016009)。

摘　　要：目的探讨脊柱后柱截骨术(posterior column osteotomy,PCO)治疗类"Lenke 5型"腰椎先天性脊柱侧凸的矫形机制及其疗效。方法2008年4月至2019年9月行PCO手术治疗且随访资料完整的腰椎先天性脊柱侧凸患者16例,男6例,女10例;年龄(23.9±11.7)岁(范围14~48岁);分节不良8例,形成障碍5例,混合型3例;平均行PCO手术节段5.3个。术中置入椎弓根螺钉后行PCO手术,去除棘突、韧带及上、下关节突,置入矫形棒矫正畸形。测量手术前后及末次随访时的腰弯Cobb角、冠状面平衡(distance between C_(7) plumbline and center sacral vertical line,C_(7)PL-CSVL)、畸形角(deformity angle,DA)、固定节段椎间隙矫正角(disc correction angle,DCA)、上端固定椎上方椎间盘角(disc angle above upper instrumented vertebra,DAAU)、下端固定椎间盘成角(lower instrumented vertebra disc angle,LDA),上端固定椎倾斜角(upper instrumented vertebra slope,US)、下端固定椎倾斜角(lower instrumented vertebra slope,LS)、下端固定椎偏移(lower instrumented vertebra offset,LO),以及胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、胸腰段交界性后凸角(thoracic junctional kyphosis,TJK)等矢状面参数。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)。结果16例患者的随访时间为(16.69±7.65)个月(范围12~36个月)。冠状面DA为26.74°±10.59°,矢状面DA为14.70°±11.63°。术前腰椎侧凸Cobb角为51.19°±12.91°,术后为23.25°±12.85°,末次随访为24.26°±13.19°,术后侧凸矫正率为57.17%±16.31%。DAAU、LDA、US、LS及LO手术后均获得改善,差异均有统计学意义(P<0.001)。矢状面参数中LL术前为33.69°±14.01°,术后增加至44.28°±10.07°,末次随访为41.97°±6.69°;TJK术前为29.02°±20.74°,术后改善至16.20°±12.62°,末次随访为16.07°±13.33°;TK术前为13.41°±12.37°,术后改善至23.52°±8.10°,末次随访为2Objective To explore the efficacy and correction mechanism of posterior column osteotomy for treatment of"Lenke 5-like"lumbar congenital scoliosis.Methods From April 2008 to September 2019,16 patients with lumbar congenital scoliosis underwent posterior column osteotomy were retrospectively reviewed including 6 males and 10 females,aged 23.9±11.7 years(range,14-48 years).Among them,8 cases were unsegmentation,5 malformation and 3 mixed type.The average segments of PCO were 5.3.Posterior column osteotomy was adapted after the insertion of pedicle screws,then removed spinous process,ligaments,superior and inferior facet and corrected the deformity with the rods.The pre-and post-operative and last follow-up radiographic parameters were measured:Cobb angle of lumbar curve,distance between C_(7) plumbline and center sacral vertical line(C_(7)PL-CSVL),deformity angle(DA),disc correction angle(DCA)of instrumented segments,disc angle above upper instrumented vertebra(DAAU),lower instrumented vertebra disc angle(LDA),upper instrumented vertebra slope(US),lower instrumented vertebra slope(LS),lower instrumented vertebra offset(LO)and sagittal parameters such as thoracic kyphosis(TK),lumbar lordosis(LL)and thoracic junctional kyphosis(TJK).The Scoliosis Research Society-22 questionnaire(SRS-22)were conducted at preoperation and the final follow up to evaluate the clinical outcomes.Results The mean follow-up period was 16.69±7.65 months(range,12-36 months).The coronal DA was 26.74°±10.59°while the sagittal DA was 14.70°±11.63°.The pre-and post-operative Cobb angle were 51.19°±12.91°and 23.25°±12.86°while the correction rate was 57.17%±16.31%and reached 24.26°±13.19°in the last follow-up.The improvement of DAAU,LDA,US,LS,and LO pre-and post-operative had statistical significance(P<0.001).The pre-and post-operative and the last follow-up C_(7)PL-CSVL were 27.13±17.08 mm,21.81±12.80 mm and 20.24±15.02 mm.The pre-operative,postoperative and last follow-up DAAU were-4.35°±2.12°,1.36°±2.34°and 1.60°±2.

关 键 词：脊柱侧凸 腰椎 截骨术 

分 类 号：R687.3[医药卫生—骨科学]