凹侧撑开术或凸侧切除术治疗先天性颈胸段侧凸畸形的对比研究  

Comparison of techniques between concave distraction or convex resection in the treatment of congenital cervicothoracic scoliosis

作　　者：曹硕 陈欣[1] 周非非[1] 赵衍斌 刁垠泽[1] 潘胜发[1] 张凤山[1] 张立[1] 夏天[1] 李危石[1] 孙宇[1] Cao Shuo;Chen Xin;Zhou Feifei;Zhao Yanbin;Diao Yinze;Pan Shengfa;Zhang Fengshan;Zhang Li;Xia Tian;Li Weishi;Sun Yu(Department of Orthopaedics,Peking University Third Hospital,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,骨与关节精准医学工程研究中心,脊柱疾病研究北京市重点实验室,北京100191

出　　处：《中华骨科杂志》2022年第7期413-425,共13页Chinese Journal of Orthopaedics

基　　金：首都临床特色应用研究与成果推广项目(Z161100000516004)。

摘　　要：目的对比凹侧撑开与凸侧切除治疗先天性颈胸段侧凸畸形的技术差异,并评价其疗效。方法收集2010年1月至2020年1月期间收治先天性颈胸段侧凸畸形8例患者的病历资料。男5例,女3例;手术时年龄为(12.5±4.5)岁(范围6~20岁)。C_(7)楔形椎1例,T_(1)半椎体及不对称蝶形4例,T_(2)半椎体2例,T_(1-2)后方小关节融合、椎板楔形变1例,均有不同程节段融合。2015年前采用凸侧切除技术(一期前后联合入路半椎体切除、环形截骨矫形术)治疗4例;2015年后采用凹侧撑开技术(一期前后联合入路行松解、椎间隙和关节突间隙撑开、cage置入融合术)治疗4例,其中2例患者行双节段凹侧撑开。记录围手术期神经、血管损伤及切口并发症发生情况。主要观察指标为手术前后及末次随访时影像学结构弯Cobb角、头尾侧代偿弯Cobb角、下颌倾斜角、颈部倾斜角、肩平衡角及头部偏移距离。结果所有患者均顺利完成手术。凸侧切除组单椎手术时间(201±100)min(范围113~300 min),单椎术中出血量(294±153)ml(范围100~450 ml),住院时间(14±3)d(范围11~18 d),随访时间(51±11)个月(范围36~60个月)。凹侧撑开组单椎手术时间(117±14)min(范围101~129 min),单椎术中出血量(119±36)ml(范围85~167 ml),住院时间(17±3)d(范围14~20 d),随访时间(28±21)个月(范围12~60个月)。凸侧切除组单椎手术时间及术中出血量均较凹侧撑开组明显增加(t=1.66,P<0.001;t=2.22,P=0.041)。凸侧切除组结构弯Cobb角术前45.1°±21.0°,术后22.7°±15.3°,差异有统计学意义(Z=6.53,P=0.038),矫正率54.8%±30.9%;头侧代偿弯Cobb角术前22.1°±8.2°,术后8.2°±5.8°,差异有统计学意义(F=6.01,P=0.049),矫正率66.8%±15.1%;下颌倾斜角术前7.8°±3.1°,术后3.5°±1.5°,差异有统计学意义(F=8.02,P=0.018),矫正率51.0%±29.7%。凹侧撑开组结构弯Cobb角术前32.2°±27.2°,术后16.3°±16.7°,差异有统计学意义(F=7.43,P=0.024),矫正率59.Objective To compare the technique between concave distraction and convex resection in the treatment of congenital cervicothoracic scoliosis and evaluate its curative effect.Methods Data of congenital cervicothoracic scoliosis patients from January 2010 to January 2020 were collected,among which 5 were males and 3 were females.The patients'age was 12.5±4.5 years old(range 6-20 years old).One case had C_(7) wedged vertebra,4 cases had T_(1) hemivertebra and unbalanced vertebra,2 cases had T_(2) hemivertebra and 1 case had fused facet joint and wedged lamina in T_(1).All patients had different degrees of vertebra fusion.Convex resection technique(one stage anterior and posterior combined hemivertebrae resection and annular osteotomy)was used to treat 4 cases before 2015;Concave distraction technique(A combination of anterior and posterior release,intervertebral space and facet space distraction,cage placed and fusion)was used to treat 4 cases after 2015 and 2 of them had 2 segments distraction.Perioperative neurological,vascular and wound related complications were recorded.The main parameters were structure Cobb angle,cephalic and caudal compensatory Cobb angle,mandibular incline,neck tilt,shoulder balance and head shift were measured pre-operation,post-operation and at the last follow-up.Results All patients'surgeries were completed successfully.In convex resection group,the duration of surgery was 201±100 min(range 113-300 min)per vertebra,the estimated blood loss was 294±153 ml(range 100-450 ml)per vertebra,the hospital stay was 14±3 d(range 11-18 d)and follow up time was 51±11 months(range 36-60 months).In concave distraction group,the duration of surgery was 117±14 min(range 101-129 min)per vertebra,the estimated blood loss was 119±36 ml(range 85-167 ml)per vertebra,hospital stay was 17±3 d(range 14-20 d)and follow up time was 28±21 months(range 12-60 months).Convex resection group had longer operation time and more blood loss per vertebra than concave distraction group.In convex resection group,stru

关 键 词：颈椎 胸椎 先天畸形 脊柱侧凸 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]