后路半椎体切除长节段骨盆固定治疗成人先天性腰骶部半椎体  

Pelvic fixation for posterior lumbosacral hemivertebra resection and long fusion in adult spinal deformity

作　　者：李松[1] 朱泽章[1] 毛赛虎[1] 马彦宇 朱奕同 刘臻[1] 史本龙[1] 孙旭[1] 乔军[1] 王斌[1] 俞杨[1] 邱勇[1] Li Song;Zhu Zezhang;Mao Saihu;Ma Yanyu;Zhu Yitong;Liu Zhen;Shi Benlong;Sun Xu;Qiao Jun;Wang Bin;Yu Yang;Qiu Yong(Department of Spine Surgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,南京210008

出　　处：《中华骨科杂志》2022年第7期426-436,共11页Chinese Journal of Orthopaedics

基　　金：江苏省临床医学中心(YXZXA2016009)。

摘　　要：目的评估成人先天性腰骶部半椎体(lumbosacral hemivertebra,LSHV)行后路半椎体(hemivertebra,HV)切除长节段固定远端是否需要骨盆固定。方法回顾性分析2005年4月至2019年8月接受后路HV切除长节段固定的成人LSHV患者32例,男12例,女20例;年龄(32.9±8.8)岁(范围21~44岁)。根据冠状面平衡(Coronal balance distance,CBD)分型:A型(术前CBD≤30 mm)15例,B型(术前CBD>30 mm且C7铅垂线向凹侧偏移)1例,C型(术前CBD>30 mm且C7铅垂线向凸侧偏移)16例。根据远端内固定模式分为骨盆固定(pelvic fixation,PF)组(PF组),即远端固定至髂骨或骶髂骨;非骨盆固定(non-pelvic fixation,NPF)组(NPF组),即远端固定至L5或S1。主要观察指标为全脊柱正、侧位X线片评估原发弯和代偿弯Cobb角、CBD改善,同时评估术后CBD分型的转变。结果32例患者术后均获得随访,随访时间为(3.9±2.6)年(范围2~11年)。术前PF组和NPF组原发弯Cobb角分别为42.6°±13.5°和41.3°±10.9°,术后矫正至13.1°±5.4°和17.7°±5.8°,末次随访时13.4°±5.1°和18.5°±6.7°,差异均有统计学意义(FPF组=32.58,FNPF组=28.64,均P<0.001),术后改善率分别为69.3%±11.8%和57.6%±10.3%(t=2.14,P=0.012)。两组代偿弯Cobb角分别由术前54.9°±14.8°和46.8°±13.6°,术后矫正至17.3°±9.6°和15.4°±8.4°,末次随访时18.5°±8.8°和17.6°±9.5°,差异均有统计学意义(FPF组=42.97,FNPF组=38.56,均P<0.001),术后改善率分别为68.4%±16.7%和67.2%±14.9%(t=0.17,P=0.849)。PF组患者原发弯和代偿弯Cobb角矫正率类似(69.3%±11.8%vs.68.4%±16.7%,t=0.15,P=0.837),而NPF组患者代偿弯Cobb角的矫正率明显高于原发弯,差异有统计学意义(67.2±14.9%vs.57.6±10.3%,t=2.13,P=0.013)。PF组和NPF组CBD分别由术前(33.3±11.2)mm和(28.8±8.1)mm,术后矫正至(18.5±3.5)mm和(27.1±6.8)mm,而末次随访时CBD均较术后无明显变化(FPF组=41.61,P<0.001;FNPF组=0.38,P=0.896);术后和末次随访时PF组CBD均优于NPF组,差异均有统计学意�Objective To evaluate whether pelvic fixation is needed in patients undergoing posterior lumbosacral hemivertebra(LSHV)resection and long fusion.Methods All 32 adult spinal deformity patients with posterior hemivertebra(HV)resection and long segment fixation treated from April 2005 to August 2019 were analyzed retrospectively,including 12 males and 20 females with a mean age of 32.9±8.8 years.According to the state of coronal balance distance(CBD),there were 15 cases of type A(preoperative CBD≤30 mm),1 case of type B(preoperative CBD>30 mm and C7 plumb line offset to the concave side),and 16 cases of type C(preoperative CBD>30 mm and C7 plumb line offset to the convex side).The clinical and imaging data before operation,immediately after operation and at the last follow-up were collected,and the short-term and long-term complications related to operation were recorded.The improvement of Cobb angle and coronal balance of primary curve and compensatory curve were evaluated on the whole spine frontal and lateral X-ray films,and the change of coronal balance type after operation was evaluated.According to the mode of distal internal fixation,the patients were divided into two groups:PF group(pelvic fixation):distal fixation to iliac or sacroiliac;NPF group(non-pelvic fixation):distal fixation to L 5 or S1.Results All 32 patients were followed up with an average time of 3.9±2.6 years(range 2-11 years).The Cobb angle of primary curve in PF and NPF groups were 42.6°±13.5°and 41.3°±10.9°respectively before operation,and corrected to 13.1°±5.4°and 17.7°±5.8°respectively after operation.It maintained at 13.4°±5.1°and 18.5°±6.7°in the two groups at the last follow-up,respectively(FPF=32.58,FNPF=28.64,P<0.001).The correction rates were 69.3%±11.8%and 57.6%±10.3%,respectively(t=2.14,P=0.012).The compensatory curves of in the two groups were corrected from 54.9°±14.8°and 46.8°±13.6°before operation to 17.3°±9.6°and 15.4°±8.4°after operation.It also maintained at 18.5°±8.8°and 17.6°±9.5�

关 键 词：脊柱侧凸 腰骶部 骨盆 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]