采用后路多棒内固定治疗重度先天性上胸段脊柱侧弯矫形的疗效  

Efficacy of applying posterior multi-rod internal fixation in severe upper thoracic congenital scoliosis orthosis

作　　者：刘仁峰 王正光 谭伟 邓幼文 周勇[1] Liu Renfeng;Wang Zhengguang;Tan Wei;Deng Youweng;Zhou Yong(Department of Spine Surgery,the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院脊柱外科,长沙410013

出　　处：《骨科临床与研究杂志》2023年第3期142-147,155,共7页Journal Of Clinical Orthopedics And Research

基　　金：湖南省科技创新人才计划科技创新团队项目(2021RC4057);中国肢残人协会脊柱侧弯公益救助项目“雏鹰计划”。

摘　　要：目的评估采用后路多棒内固定技术治疗重度先天性上胸段脊柱侧弯的近期临床效果。方法对2017年1月到2022年6月中南大学湘雅三医院脊柱外科治疗的重度先天性上胸段脊柱侧弯患者20例的临床资料进行回顾性分析。依手术方法将全部患者分为两组:多棒内固定组(n=10)采用后路多棒内固定结合僵硬区远端多节段Ponte截骨术;传统双棒内固定组(n=10)采用传统双棒内固定结合后路全脊椎截骨术(PVCR)或经椎弓根椎体截骨(PSO)。记录患者一般临床资料以及手术时间、术中出血量、融合节段数量、多棒链接位置和术后并发症等,同时分别测量患者术前、术后及末次随访时侧弯Cobb角、最大后凸Cobb角(GK)、矢状面平衡参数(SVA)和冠状面平衡参数(C 7PL-CSVL)等影像学指标,并进行组内与组间比较。结果随访(18.10±3.73)(13~23)个月。多棒内固定组患者手术时间和术中出血量均较传统双棒内固定组显著减少(均P<0.05)。两组患者术后侧弯Cobb角、GK、SVA和C 7PL-CSVL均较术前有显著改善(均P<0.05)。多棒内固定组患者术后侧弯Cobb角矫正率为(64.62±7.43)%,GK矫正率为(31.16±12.48)%,稍高于传统双棒内固定组的(62.84±6.35)%和(32.55±9.878)%,但差异均无统计学意义(均P>0.05)。随访期间未见矫形区上、下端继发脊柱侧弯、后凸或失衡;两组患者身高增加(8.60±1.10)(6.5~10.0)cm,外观改善均令人满意。多棒内固定组出现术后并发症3例,包括表皮伤口感染1例和肌间静脉血栓形成2例;传统双棒内固定组出现并发症5例,包括表皮伤口感染2例、脑脊液漏1例和肌间静脉血栓形成2例;两组均未见神经相关并发症。对全部并发症均行对症治疗。结论后路多棒内固定结合僵硬区远端多节段Ponte截骨在重度先天性上胸段脊柱侧弯患者的治疗中可获得安全可靠的近期效果,尤其适用于后凸不严重的上胸段僵硬先天性脊柱侧弯病例�Objective To evaluate the short-term effect of posterior multi-rod internal fixation in correcting severe upper thoracic congenital scoliosis.Methods Clinical data of 20 cases of severe upper thoracic congenital scoliosis treated in the Department of Spine Surgery,the Third Xiangya Hospital of Central South University from January 2017 to June 2022 were retrospectively analyzed.All cases were divided into 2 groups according to the surgery operation.Ten patients treated with posterior multi-rod internal fixation and multi-segment Ponte osteotomy at the distal end of the rigid area were included in the multi-rod group;10 patinets treated with traditional double-rod internal fixation and posterior vertebral column resection(PVCR)/pedicle subtraction osteotomy(PSO)were included in the double-rod group.The operation time,blood loss,fusion segment,multi-rod link position and postoperative complications of all patients were recorded.At the same time,the radiographic parameters including scoliosis Cobb's angle,maximum kyphotic Cobb's angle(global kyphosis,GK),sagittal balance(sagittal vertical axis,SVA)and coronal balance[(distance from C 7 plumb line(C 7PL)to center sacral vertical line(CSVL),C 7PL-CSVL]were measured preoperatively,postoperatively and at the last follow-up.All observations were compared within and between the 2 groups.Results The follow-up duration was(18.10±3.73)(13~23)months.The operation time and intraoperative blood loss in the multi-rod group were significantly less than those in the double-rod group(both P<0.05).The postoperative Cobb's angle,GK,SVA and C 7PL-CSVL were improved significantly in both groups.The correction rate of Cobb's angle and GK of the multi-rod group[(64.62±7.43)%and(37.16±12.48)%]were slightly higher than that of the double-rod group[(62.84±6.35)%and(32.55±9.88)%],but the differences were not statistically significant(both P>0.05).No secondary scoliosis,kyphosi s or imbalance in the upper and lower end of the correction area were found during the follow-up.The height of

关 键 词：脊柱侧凸 胸椎 先天畸形 矫形外科固定装置 内固定器 截骨术 

分 类 号：R687.3[医药卫生—骨科学]