多节段后柱截骨术治疗僵硬性成人特发性脊柱侧凸疗效及影响因素分析  

Clinical outcome and influencing factors analysis of multi-level posterior column osteotomy in the treatment of rigid adult idiopathic scoliosis

作　　者：张扬璞 海涌[1] 孟祥龙[1] 陶鲁铭 韩渤 杨宏浩 赵志恒 ZHANG Yang-pu;HAI Yong;MENG Xiang-long;TAO Lu-ming;HAN Bo;YANG Hong-hao;ZHAO Zhi-heng(Department of Orthopedic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中国骨与关节杂志》2022年第7期492-497,共6页Chinese Journal of Bone and Joint

摘　　要：目的评估一期后路多节段后柱截骨术(multi-level posterior column osteotomy,MPCO)治疗僵硬性成人特发性脊柱侧凸(adult idiopathic scoliosis,AdIS)的术后疗效与主弯矫正的相关独立影响因素。方法回顾性分析2012年2月至2019年6月,在我院接受一期后路MPCO的79例僵硬性(主弯柔韧度<25%)AdIS住院患者的临床资料,其中男20例,女59例;平均年龄(29.23±10.63)岁。患者术前主弯Cobb’s角平均(88.21±19.90)°,主弯柔韧性平均(12.75±7.17)%。收集患者一般资料[性别、年龄、体质量指数(body mass index,BMI)]、临床资料(后柱截骨节段、融合节段、椎弓根螺钉植入数目、主弯矫正率、术中出血量、手术时间等)以及影像学资料(主弯Cobb’s角、主弯柔韧性、主弯涉及节段、顶椎偏移度等冠、矢状位参数)等分析患者的术后疗效。根据患者术后平均主弯矫正率将患者分为高矫正率组与低矫正率组,并通过单因素分析和多因素Logistic回归分析确定主弯矫正率的独立影响因素。结果所有患者均成功接受一期后路MPCO,平均手术时间为(289.43±73.32)min,平均出血量为(901.84±659.19)ml,平均截骨节段为(4.63±1.00)个。术后患者主弯的平均Cobb’s角改善至(36.85±17.40)°,主弯平均矫正率为(59.36±13.37)%。将研究中各参数进行分组对比后确定参数主弯Cobb’s角,主弯柔韧性及主弯涉及节段的差异有统计学意义,进一步将其与其它潜在影响因素一并纳入多因素Logistic分析,最终确认主弯涉及节段(OR=8.706,95%CI=1.829~41.433)、截骨数目(OR=5.331,95%CI=1.097~25.904)、主弯柔韧性(OR=1.178,95%CI=1.067~1.302)以及冠状位平衡(OR=0.957,95%CI=0.923~0.992)为影响主弯矫正的独立影响因素。结论MPCO是治疗AdIS的有效手术方法,而影响其主弯矫正的独立因素包括主弯涉及节段、截骨数目、主弯柔韧性以及冠状位平衡。全面评估患者畸形影像学特点并合理选择截骨数目,才能�Objective:To evaluate clinical outcomes of one-stage posterior multi-level posterior column osteotomy(MPCO)for rigid adult idiopathic scoliosis(AdIS)and the independent factors affecting major curve correction.Methods A retrospective analysis of the clinical data of 79 inpatients with rigid AdIS(main curve flexibility<25%)who underwent one-stage posterior MPCO in our hospital from February 2012 to June 2019,including 20 males and 20 females 59 cases;mean age(29.23±10.63)years old.The average preoperative Cobb’s angle of the main curve was(88.21±19.90)°,and the average flexibility of the main curve was(12.75±7.17)%.The general data(sex,age,body mass index),clinical data(posterior column osteotomy segment,fusion segment,number of pedicle screws implanted,main curve correction rate,intraoperative blood loss and surgical time etc.)and radiographic data including coronal and sagittal parameters(main curve Cobb’s angle,main curve flexibility,main curve involved segments,and apical vertebra translation etc.)were collected and analyzed.The patients were divided into a high correction rate group and a low correction rate group according to the average postoperative correction rate of the main curve,and the independent influencing factors of the correction rate of the main curvature were determined by univariate analysis and multivariate logistic regression analysis.Results All patients successfully underwentone-stage posterior MPCO.The average operation time was(289.43±73.32)min,the average blood loss was(901.84±659.19)ml,and the average osteotomy segment was(4.63±1.00).The mean Cobb’s angle of the main curvature of the patients was improved to(36.85±17.40)°after operation,and the mean correction rate of the main curvature was(59.36±13.37)%.The differences in the main curve Cobb’s angle,flexibility of the main curve and the segments involved in the main curve between the two groups were statistically significant.They were further included in the multivariate Logistic analysis together with other potentia

关 键 词：脊柱侧凸 截骨术 矫形外科手术 

分 类 号：R687.3[医药卫生—骨科学] R682.3[医药卫生—外科学]