前后联合入路卫星棒翻修治疗严重胸腰椎后凸后路全脊椎截骨术后断棒的疗效  

Efficacy of satellite rod revision surgery via a combined anterior and posterior approach for rod fracture after posterior vertebral column resection in patients with severe thoracolumbar kyphosis

作　　者：张锴 高延征 王红强 朱卉敏 邢帅 张广泉 胡巍然 Zhang Kai;Gao Yanzheng;Wang Hongqiang;Zhu Huimin;Xing Shuai;Zhang Guangquan;Hu Weiran(Department of Spine and Spinal Cord Surgery,Henan Provincial People′s Hospital(People′s Hospital of Zhengzhou University),Zhengzhou 450003,China;Department of Minimally Invasive Spine Surgery,Luoyang Orthopedic Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Zhengzhou 450016,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)脊柱脊髓外科,郑州450003 [2]河南省洛阳正骨医院(河南省骨科医院)脊柱微创外科,郑州450016

出　　处：《中华创伤杂志》2023年第7期627-635,共9页Chinese Journal of Trauma

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220036);河南省医学科技攻关计划(SB201901085)。

摘　　要：目的探讨前后联合入路卫星棒翻修治疗严重胸腰椎后凸后路全脊椎截骨(PVCR)术后断棒的临床疗效。方法采用回顾性病例系列研究分析2013年1月至2021年1月河南省人民医院收治的11例严重胸腰椎后凸PVCR术后断棒患者的临床资料,其中男6例,女5例;年龄21~62岁[(35.4±13.0)岁]。创伤性后凸4例,先天性后凸4例,结核性后凸3例。患者均存在明显腰背部疼痛。根据美国脊髓损伤协会(ASIA)分级:C级2例,D级2例,E级7例。采用前后联合入路卫星棒技术行内固定翻修手术治疗。记录手术时间、术中出血量、术后住院时间。测量术前、术后1周及末次随访时后凸和侧凸Cobb角、冠状面上C_(7)铅垂线与骶正中线的距离(C_(7)‑CSVL)和矢状面上C_(7)铅垂线与骶后上角的距离(SVA)等影像学指标;同时采用视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、简体中文版脊柱侧凸研究学会22项问卷量表(SRS‑22)评分等评估临床疗效。末次随访时,采用Suk标准评价植骨融合情况,采用ASIA分级评估神经功能恢复情况。观察并发症情况。结果患者均获随访24~84个月[(47.5±16.2)个月]。手术时间为100~220 min[(149.4±37.6)min],术中出血量为150~350 ml[(246.3±64.6)ml],术后住院时间为5~8 d[(6.1±1.1)d]。术后1周及末次随访时后凸Cobb角为(18.5±3.2)°、(19.3±2.9)°,侧凸Cobb角为(11.8±2.2)°、(11.1±2.2)°,分别较术前的(60.4±6.3)°、(21.7±5.5)°有明显改善(P均<0.01),平均Cobb角矫正率分别为69.4%和45.6%;末次随访时后凸和侧凸Cobb角与术后1周比较,差异无统计学意义(P均>0.05)。C_(7)‑CSVL由术前(21.2±4.3)mm矫正至术后1周(15.7±2.4)mm、末次随访(15.9±2.2)mm;SVA由术前(51.0±6.8)mm矫正至术后1周(16.6±3.6)mm、末次随访(15.3±3.9)mm(P均<0.01);末次随访与术后1周比较,差异无统计学意义(P均>0.05)。术后1周及末次随访时VAS为(2.5±0.9)分、(1.9±0.9)分,ODI为20.1±5.4、18.4±5.2,SRS‑22�Objective To investigate the clinical efficacy of satellite rod revision surgery via a combined anterior and posterior approach for rod fracture after posterior vertebral column resection(PVCR)in patients with severe thoracolumbar kyphosis.Methods A retrospective case series study was conducted on the clinical data of 11 patients with rod fracture after PVCR for severe thoracolumbar kyphosis,who were treated in Henan Provincial People′s Hospital from January 2013 to January 2021.There were 6 males and 5 females,with the age range of 21‑62 years[(35.4±13.0)years].Among them,4 patients had traumatic kyphosis,4 presented congenital kyphosis and 3 showed tuberculous kyphosis.All the patients had obvious low back pain.According to the American Spinal Injury Association(ASIA)score,2 patients were found with grade C,2 with grade D and 7 with grade E.All the patients underwent revision surgery for internal fixation using satellite rod via a combined anterior and posterior approach.The operation time,intraoperative blood loss and postoperative hospital stay were recorded.The imaging parameters such as kyphosis Cobb angle,scoliosis Cobb angle,distance between C_(7) plumb line and central sacral vertical line(C_(7)‑CSVL),and distance between C_(7) plumb line and sagittal vertical axis(SVA)were measured preoperatively,at 1 week postoperatively and at latest follow‑up.At the same time,the visual analogue scale(VAS),Oswestry dysfunction index(ODI),and simplified Chinese version of the scoliosis research society‑22(SRS‑22)questionnaire were used to evaluate the clinical efficacy.At the latest follow‑up,the osteotomy fusion was evaluated by Suk criterion and ASIA score was used to evaluate the recovery of neurological function.The complications were also recorded for the patients.Results All the patients were followed up for 24‑84 months[(47.5±16.2)months].The operation time was 100‑220 minutes[(149.4±37.6)minutes],with the intraoperative blood loss of 150‑350 ml[(246.3±64.6)ml]and the postoperative hospi

关 键 词：脊柱损伤 胸椎 腰椎 脊柱后凸 翻修术 

分 类 号：R687.3[医药卫生—骨科学]