双头椎弓根螺钉卫星棒矫形技术促进休门氏病后凸畸形的椎体重塑  

Adding satellite rods to standard two-rod construct for promoting postoperative vertebral remodeling in scheuermann kyphosis

作　　者：王斯年 邱勇[1] 朱泽章[1] 王斌[1] 徐亮[1] 蒲小江 孙旭[1] Wang Sinian;Qiu Yong;Zhu Zezhang;Wang Bin;Xu Liang;Pu Xiaojiang;Sun Xu(Division of Spine Surgery,Department of Orthopaedics,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骨科脊柱外科,南京210008

出　　处：《中华骨科杂志》2022年第17期1139-1147,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金面上项目(81772422);江苏省骨科临床医学中心资助课题(YXZXA2016009)。

摘　　要：目的探讨卫星棒技术对休门氏病后凸畸形后路截骨矫形内固定治疗后维持矫正效果和促进椎体重塑的作用。方法回顾性分析2009年1月至2018年12月接受矫正手术治疗且随访至少2年的休门氏病后凸畸形患者26例,男21例、女5例,年龄(14.5±0.9)岁(范围13~16岁)。Risser征1级5例、2级10例、3级11例。采用双棒固定(双棒固定组)13例、双棒+卫星棒固定(卫星棒固定组)13例。比较两组术前、术后即刻和末次随访时的椎体前缘高度(anterior vertebral body height,AVBH)、椎体后缘高度(posterior vertebral body height,PVBH)、整体后凸Cobb角(global kyphosis,GK)、椎间盘楔变角(disc wedging angle,DWA)、椎体楔变角(vertebral wedging angle,VWA)和脊柱侧凸研究学会-22简明问卷评分(Scoliosis Research Society questionnaires-22,SRS-22)。结果卫星棒固定组和双棒固定组术后随访时间分别为(3.1±1.0)年和(2.9±1.1)年,差异无统计学意义(t=0.04,P=0.837)。术后卫星棒固定组和双棒固定组矫正率分别为51.1%±5.1%、46.7%±5.8%,差异无统计学意义(t=1.74,P=0.099)。随访期间卫星棒固定组患者矫正丢失0.6°±0.3°,低于双棒固定组的1.8°±0.8°,差异有统计学意义(t=-6.52,P<0.001)。与术后即刻相比,末次随访时卫星棒固定组和双棒固定组发生楔形变椎体的AVBH/PVBH比值均增加(P<0.05);卫星棒固定组楔形变最严重椎体的AVBH/PVBH比值增长率为32.6%±8.5%,高于双棒固定组的22.5%±13.4%,差异有统计学意义(t=2.31,P=0.030)。两组患者术前、术后即刻和末次随访时SRS-22评分的差异均无统计学意义(P>0.05)。结论休门氏病患者矫形术后楔形变椎体的前缘高度明显增加;相比于传统双棒技术,应用卫星棒技术可获得更明显的椎体重塑和更少的矫正丢失。Objective To investigate reversal of vertebral wedging and to evaluate the contribution of adding satellite rods to correction maintenance in patients with adolescent Scheuermann kyphosis(SK)after posterior-only instrumented correction.Methods A retrospective cohort study with SK was performed.From January 2009 to December 2018,a total of 26 SK patients(21 males and 5 females)who received posterior instrumented correction surgery at the age of 13–16 years were included.The mean age was 14.5±0.9 years.Risser sign was level 1 in 5 patients,level 2 in 10 patients and level 3 in 11 patients.Patients receiving placement with a standard 2-RC construct were composed in the 2-RC group,and those with enhanced instrumentation with satellite rods adding to 2-RC via duet screws were assigned to the S-RC group.The anterior vertebral body height(AVBH),posterior vertebral body height(PVBH),global kyphosis(GK),disc wedging angle(DWA),vertebral wedging angle(VWA)and Scoliosis Research Society questionnaires-22(SRS-22)were collected preoperatively,immediately postoperatively,and at the latest follow-up.Further,these outcomes were compared between the two groups.Results The average follow-up durations for the S-RC and 2-RC groups were 3.1±1.0 and 2.9±1.1 years(t=0.04,P=0.837),respectively.Remarkable postoperative correction of GK was observed in S-RC group and 2-RC group without significant difference(51.1%±5.1%vs.46.7%±5.8%,t=1.74,P=0.099).The correction loss of S-RC group was significantly less than that at 2-RC group during follow-up(0.6°±0.3°vs.1.8°±0.8°,t=-6.52,P<0.001).The ratio between AVBH and PVBH of deformed vertebrae notably increased in S-RC group and 2-RC group from post-operation to the latest follow-up(P<0.05).Compared with the 2-RC group,the S-RC group had significantly greater increase in AVBH/PVBH ratio during follow-up(32.6%±8.5%vs.22.5%±13.4%,t=2.31,P=0.030).The two groups had similar preoperative and postoperative SRS-22 questionnaire scores for all domains(P>0.05).Conclusion The AVBH of deformed

关 键 词：SCHEUERMANN病 脊柱后凸 脊柱融合术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]