退变性脊柱畸形截骨多节段经椎间孔椎间融合  

Posterior column osteotomy combined with multi-level transforaminal lumbar interbody fusion for degenerative spinal deformity

作　　者：周若南[1] 王祥善[1] 张华[1] 寇德鹏 ZHOU Ruo-nan;WANG Xiang-shan;ZHANG Hua;KOU De-peng(Depurtmert of Spine Surgery,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China)

机构地区：[1]河南省郑州市骨科医院脊柱三科,河南郑州450052

出　　处：《中国矫形外科杂志》2023年第5期418-423,共6页Orthopedic Journal of China

摘　　要：[目的]评价脊柱后柱截骨(posterior column osteotomy,PCO)联合局部经椎间孔入路腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗退变性脊柱侧后凸畸形的效果。[方法]回顾性分析郑州市骨科医院2018年1月—2021年6月手术治疗的退变性脊柱侧后凸畸形71例患者的临床资料。依据术前医患沟通结果,40例采用PCO联合局部TLIF(截骨融合组),另外31例采用≥3级截骨矫形固定术(截骨固定组)。比较两组围术期情况、随访结果和影像评估指标。[结果]截骨融合组并发症发生率为7.5%(3/40),截骨固定组为25.8%(8/31),差异有统计学意义(P=0.034)。截骨融合组手术时间、术中失血量、下地行走时间、完全负重活动时间均优于截骨固定组(P<0.05),两组切口总长度、术中透视次数、切口愈合等级、住院时间比较差异均无统计学意义(P>0.05)。随访12个月以上,随时间推移,两组VAS和ODI评分显著减少(P<0.05),JOA评分显著增加(P<0.05)。出院时截骨融合组的上述临床评分均显著优于截骨固定组(P<0.05)。影像方面,与术前相比,术后即刻和末次随访时两组主弯冠状面Cobb角、矢状面Cobb角、冠状面平衡和矢状面平衡均显著改善(P<0.05);相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。末次随访时两组均无钉棒松动、断裂等不良影像表现。[结论]对退变性脊柱侧后凸畸形患者采用PCO联合局部TLIF效果良好,且可减轻手术创伤、降低手术风险、加快术后康复、减少并发症。[Objective]To evaluate the clinical outcomes of posterior column osteotomy(PCO)combined with local multi-level transforaminal lumbar interbody fusion(TLIF)in the treatment of degenerative scoliokyphosis.[Methods]A retrospective study was performed on 71 patients who received surgical treatment for degenerative spine deformity in our hospital from January 2018 to June 2021.Based on preoperative doctor-patient communication,40 patients received PCO combined with local mutipl-level TLIF(PCO-MF group),while the remaining 31 patients received grade≥3 osteotomy and fixation(OF group).The documents regarding perioperative conditions,follow-up and radiographs were compared between the two groups.[Results]The incidence of early complications was of 7.5%(3/40)in the PCO-MF group,whereas 25.8%(8/31)in the OF group,which was statistically significant(P=0.034).The PCO-MF group proved significantly superior to the OF group in terms of operative time,intraoperative blood loss,postoperative walking time and full weight-bearing activity time(P<0.05),although there were no significant differences in the total incision length,intraoperative fluoroscopy times,incision healing and hospital stay between the two groups(P>0.05).With time of follow-up for more than 12 months,the VAS and ODI scores significantly decreased(P<0.05),while JOA score significantly increased in both groups(P<0.05),which in the PCO-MF group was significantly better than those in the OF group at discharge(P<0.05).Radiographically,the main curved coronal Cobb angle,sagittal Cobb angle,coronal balance and sagittal balance significantly improved in both groups immediately after surgery and at the latest follow-up compared with those preoperatively(P<0.05),nevertheless no significant differences in the above image parameters were noted between the two groups at any time point accordingly(P>0.05).At the latest follow-up,non-patient in both groups had adverse imaging manifestations such as loosening and fracture of the implants.[Conclusion]PCO combined with local mul

关 键 词：退变性脊柱侧后凸畸形 脊柱后柱截骨 经椎间孔腰椎椎间融合术 

分 类 号：R687.3[医药卫生—骨科学]