微创猫眼侧方腰椎融合术对重度成人退变性脊柱侧凸后路矫正融合节段选择的影响  

Role of crenel lateral lumbar interbody fusion in the precise selection of fusion level in posterior correction for adult degenerative scoliosis

作　　者：李浩[1] 徐正宽[1] 陈其昕[1] 李方财[1] Li Hao;Xu Zhengkuan;Chen Qixin;Li Fangcai(Department of Orthopedics,the Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院骨科中心脊柱外科,杭州310009

出　　处：《中华外科杂志》2022年第1期69-78,共10页Chinese Journal of Surgery

基　　金：国家自然科学基金(81501908);国家卫生健康委员会科研基金(WKJ-ZJ1903);浙江省自然科学基金(LY19H060005)。

摘　　要：目的探讨微创猫眼侧方腰椎融合术(CLIF)对重度成人退变性脊柱侧凸后路矫正融合节段选择的影响。方法本研究为前瞻性研究。纳入2016年6月至2019年3月浙江大学医学院附属第二医院骨科中心脊柱外科收治的Lenke-Silva分级为Ⅴ级和Ⅵ级的重度成人退变性脊柱侧凸患者。入组患者首先完成术前临床和影像学检查,评估Lenke-Silva分级,确定Ⅰ期CLIF手术节段,同时预判如行单纯后路矫形需融合节段数;Ⅰ期术后再次评估Lenke-Silva分级,将患者分为有效组(Lenke-Silva分级降低)和无效组(Lenke-Silva分级不变),根据二次评估的结果制定Ⅱ期后路手术方式。比较两组患者实际融合节段与预计行单纯后路矫形需融合节段的差值、分期手术前后及末次随访时侧凸Cobb角、冠状面与矢状面影像学参数、疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),分析Lenke-Silva分级降低的影响因素。组间比较采用独立样本t检验、重复测量方差分析、秩和检验、χ^(2)检验或Fisher确切概率法。结果共54例患者纳入本研究。男性8例,女性46例,年龄(68.8±5.8)岁(范围:56~77岁),术前Lenke-Silva分级:Ⅴ级26例,Ⅵ级28例。行Ⅰ期CLIF 194个节段,其中114个节段(58.8%)行前柱松解重建术(ACR),15个节段(7.7%):使用大角度融合器。Ⅰ期术后,32例患者(22例Ⅴ级、10例Ⅵ级)Lenke-Silva分级降低,纳入有效组;22例患者(4例Ⅴ级、18例Ⅵ级)Lenke-Silva分级无变化,纳入无效组。有效组中32例患者术前侧凸顶椎位置均在L1以下,无效组中18例(81.8%,18/22)患者术前侧凸顶椎位置在L1以下,差异有统计学意义(P=0.023);有效组患者椎间隙前方均无连续性骨赘,无效组中7例椎间隙前方有连续性骨赘(31.8%,7/22),差异有统计学意义(P=0.001)。有效组患者Ⅰ期术中行ACR(71.2%比39.5%,χ^(2)=20.660,P<0.01)和使用大角度融合器的节段更多(12.7%比0,P=0.001),而术后严重融合器下沉节�Objective To investigate the role of minimally invasive crenel lateral lumbar interbody fusion(CLIF)in the decision of fusion level in posterior correction for severe adult degenerative scoliosis.Methods This is a prospective study.Patients with levelⅤandⅥof Lenke-Silva classification who were treated at Department of Orthopedics,the Second Affiliated Hospital,School of Medicine,Zhejiang University from June 2016 to March 2019 were included.First,the enrolled patients completed the preoperative clinical and imaging examination,the Lenke-Silva classification was evaluated,the surgical segments in first-stage CLIF was determined and the fusion segments required for single-stage posterior correction was predicted.After the first-stage CLIF,patients received reassessment of Lenke-Silva classification and global coronal and sagittal balance.Patients were divided into two groups:the effective group(level of Lenke-Silva classification decreased)and the ineffective group(level of Lenke-Silva classification unchanged).Second-stage posterior surgery was performed based on the results of reassessments.The fusion segment,Cobb angle,parameters of global coronal and sagittal plane,visual analogue pain score(VAS)and Oswestry disability index(ODI)were compared between the two groups preoperatively,after first-stage CLIF,second-stage posterior fixation and at the final follow-up.The potential factors associated with the decrease of the level of Lenke-Silva classification were recorded and compared between the two groups.Independent sample t test,repeated measure analysis of variance,rank sum test,χ^(2) test or Fisher exact method were used to compare the difference among groups.Results Fifty-four patients were enrolled,including 8 males and 46 females,aged(68.8±5.8)years(range:56 to 77 years).Preoperatively,26 patients were classified as levelⅤby Lenke-Silva classification,28 cases were gradeⅥ.CLIF was performed in 194 segments,with 114 segments(58.8%)receiving anterior column realignment(ACR)and 15 segments(7.7%)using

关 键 词：脊柱侧凸 脊柱融合术 成人退变性脊柱侧凸 Lenke-Silva分级 分期手术 

分 类 号：R687.3[医药卫生—骨科学]