术前磁共振不同脊髓形态分型脊柱畸形三柱截骨矫形术后神经并发症的发生情况  

Neurological complications after three-column osteotomy in spinal deformity patients with different magnetic resonance imaging-based classification of spinal cord shape

作　　者：史本龙[1] 刘万友 李洋[1] 刘臻[1] 孙旭[1] 朱泽章[1] 邱勇[1] Shi Benlong;Liu Wanyou;Li Yang;Liu Zhen;Sun Xu;Zhu Zezhang;Qiu Yong(Division of Spine Surgery,Department of Orthopedic 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 Xuzhou Medical University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008 [2]徐州医科大学鼓楼临床学院脊柱外科,南京210008

出　　处：《中华医学杂志》2022年第5期344-349,共6页National Medical Journal of China

基　　金：江苏省自然科学基金青年基金(BK20170126);南京市医学科技发展资金一般性课题(CZLB1480-202)。

摘　　要：目的比较不同术前顶椎区MRI脊髓形态分型的严重胸椎侧后凸畸形患者行三柱截骨矫形术的神经并发症发生情况。方法回顾性分析2015年8月至2018年8月于南京鼓楼医院行手术治疗的胸椎侧后凸畸形患者共112例的临床资料。其中男52例,女60例,年龄13.5岁(9.0~38.5岁)。测量的影像学参数包括顶椎区脊髓形态分型、主弯侧凸Cobb角、冠状面平衡(C7PL-CSVL)、最大后凸Cobb角(GK)、矢状面偏移(SVA)。利用Frankel分级分组并评估各组术前、术后及随访时的神经功能状态。结果112例患者术前顶椎区脊髓形态分型为Ⅰ型8例(7.1%)、Ⅱ型58例(51.8%)、Ⅲ型46例(41.1%)。所有患者的末次随访时间为(28.5±3.4)个月。与术前相比,3组患者术后主弯侧凸Cobb角、C7PL-CSVL、GK、SVA均有显著矫正,手术前后差异均有统计学意义(均P<0.05),末次随访时与术后即刻差异均无统计学意义(均P>0.05),均无矫正丢失。3例术前脊髓形态为Ⅱ型的患者术后出现新发神经损害,Frankel分级均为D级;6例术前脊髓形态为Ⅲ型的患者术后出现新发神经损害,Frankel分级为C级1例、D级5例;3例术前脊髓形态为Ⅲ型的患者出现已有神经功能损害加重,Frankel分级均由术前的D级加重至C级。脊髓形态为Ⅲ型的患者术后新发神经损害或已有神经损害加重的发生率比Ⅱ型患者更高(19.6%比5.2%,P=0.037)。结论术前MRI脊髓形态分型与严重胸椎侧后凸畸形患者三柱截骨矫形神经并发症具有一定关联,术前脊髓形态为Ⅲ型的患者术后神经并发症的发生率更高。Objective To compare the incidences of neurological complications after three-column osteotomy based on the magnetic resonance imaging(MRI)-based classification of spinal cord shape and cerebrospinal fluid in patients with severe thoracic kyphoscoliosis.Methods A total of 112 patients(52 males,60 females,age(M(Q1,Q3))13.5 years(9.0-38.5 years))with thoracic kyphoscoliosis who underwent three-column osteotomy in Nanjing Drum Tower Hospital from August 2015 to August 2018 were retrospectively analyzed.The radiographic parameters including spinal cord morphology at apex,Cobb angle of main curve,distance between C7 plumb line and center sacral vertical line(C7PL-CSVL),global kyphosis(GK)and sagittal vertical axis(SVA)were measured,retrospectively.The Frankel scoring system was used for the evaluation of neurological status at pre-operation,post-operation and the last follow-up.Results The spinal cord morphologies at apex were classified into typeⅠin 8(7.1%)patients,typeⅡin 58(51.8%),and typeⅢin 46(41.1%),respectively.The patients were followed-up for(28.5±3.4)months.Compared with pre-operation,the Cobb angle of main curve,C7PL-CSVL,GK and SVA showed significantly improvement at post-operation(all P<0.05)and with no significant correction loss at the last follow-up(all P>0.05).New neurological complications were detected in 3 patients with typeⅡspinal cord shape,of whom the neurological scores were Frankel D at post-operation.For patients with typeⅢspinal cord shape,new neurological complications were detected in 6 patients including 1 Frankel C and 5 Frankel D.In addition,deterioration of neurological status from Frankel D to Frankel C was found in 3 patients with typeⅢspinal cord shape.The incidence of new or deteriorating neurological complications in patients with typeⅢspinal cord shape was higher than that in typeⅡpatients(19.6%vs 5.2%,P=0.037).Conclusions The MRI-based classification is associated with post-operative neurological complications in patients with severe kyphoscoliosis undergoing th

关 键 词：截骨术 脊髓形态分型 脊柱畸形 神经并发症 三柱截骨 侧后凸畸形 

分 类 号：R687.3[医药卫生—骨科学]