"SSV-1"作为胸椎后凸型休门氏病后凸畸形远端融合椎的临床疗效  

Clinical outcomes of selecting the vertebra above sagittal stable vertebra as distal fusion level for Scheuermann's thoracic kyphosis

作　　者：胡宗杉 许彦劼 徐辉 阿布都哈卡尔·克拉木 凌宸 李东岳 刘臻[1] 朱泽章[1] 邱勇[1] Hu Zongshan;Xu Yanjie;Xu Hui;Abdukahar·Kiram;Ling Chen;Li Dongyue;Liu Zhen;Zhu Zezhang;Qiu Yong(Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,Medical School of Nanjing University,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》2023年第16期1068-1075,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82272545);中国博士后基金面上资助项目(2021M701677)。

摘　　要：目的探讨胸椎后凸型休门氏病后凸畸形(Scheuermann thoracic kyphosis,STK)行后路融合手术时选择矢状面稳定椎上方椎体(sagittal stable vertebra-1,SSV-1)作为远端固定椎(lowest instrumented vertebra,LIV)的临床疗效。方法2018年1月至2021年6月于南京大学医学院附属鼓楼医院接受后路矫形融合手术治疗STK患者57例,男52例、女5例,年龄(16.8±3.5)岁(范围12~30岁)。随访时间(33.0±7.3)个月(范围24~53个月)。根据LIV的选择不同分为两组,矢状面稳定椎(sagittal stable vertebra,SSV)组36例,即LIV位于SSV;SSV-1组21例,即LIV位于SSV上方椎体。比较两组患者的整体后凸角(global kyphosis,GK)、腰椎前凸角(lumbar lordosis,LL)、矢状面平衡(sagittal vertical axis,SVA)、LIV偏移距离、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)及骶骨倾斜角(sacral slope,SS)。术前及末次随访时采用脊柱侧凸研究学会-22简明量表调查问卷(Scoliosis Research Society questionnaires-22,SRS-22)评估临床疗效。记录患者术中及术后随访期间的并发症发生情况,比较两组间矢状面形态的影像学测量参数及术后远端交界性后凸(distal junctional kyphosis,DJK)的发生率。结果两组患者的性别、年龄、随访时间、手术时间、术中出血量及融合节段的差异均无统计学意义(P>0.05)。术前SSV组LIV偏移距离为(-7.9±11.0)mm,小于SSV-1组的(31.5±11.5)mm,差异有统计学意义(t=7.64,P<0.001)。SSV组术前GK为79.3°±10.5°,术后1周减小至44.4°±8.5°(t=28.28,P<0.001),矫正率为44.0%±7.6%;SSV-1组术前GK为81.1°±10.6°,术后1周减小至44.9°±7.8°(t=22.23,P<0.001),矫正率为44.6%±7.0%。SSV-1组与SSV组患者术前、术后1周及末次随访时GK、LL、SVA、PI、PT及SS的差异均无统计学意义(P>0.05)。所有患者术中均无神经损伤。随访期间SSV-1组有1例患者发生DJK,未见近端交界性后凸、假关节形成、内固定失败等并发症。末次随访时SSV-1患�Objective To investigate the clinical outcome and complications associated with utilizing sagittal plane stable vertebra-1(SSV-1)as the distal instrumented vertebra(LIV)in posterior fusion of thoracic kyphosis with Scheuermann's Disease kyphosis(STK).MethodsA longitudinal study on patients with STK who underwent posterior correction and fusion surgery from January 2018 to June 2021 were conducted.All participants had a follow-up duration over two years.Patients were divided into two groups according to the segment of LIV:the SSV group,where LIV was located in SSV;and the SSV-1 group,where LIV was located in the vertebral body above SSV.The radiographic parameters,including global kyphosis(GK),lumbar lordosis(LL),and sagittal plane(SVA),LIV offset distance(LIV translation),pelvic incidence(PI),pelvic tilt(PT)and sacral slope(SS),were compared between the two groups.The SRS-22 scale was used to evaluate health-related quality of life at pre-operation and last follow-up,and the incidence of postoperative distal junctional kyphosis(DJK)was also recorded.Analytical techniques,such as Analysis of Variance and Mann-Whitney tests,were employed to compare inter-group differences.ResultsA total of 57 patients were included in the study,36 in the SSV group and 21 in the SSV-1 group.The average age for patients were 16.1±2.3 years(range 13-20 years),and the average follow-up time was 32.8±6.8 months(range 24-53 months).There were no statistically significant differences between the two groups in terms of gender,age,follow-up time,surgical time,intraoperative bleeding volume,and fusion level.Before surgery,the LIV deviation distance in the SSV group was significantly lower than that in the SSV-1 group(-7.9±11.0 mm vs.31.5±11.5 mm,t=7.64,P<0.001).In the SSV group,the preoperative GK was 79.3°±10.5°,and the last follow-up GK was 44.4°±8.5°,which was significantly improved compared to preoperative value(t=28.28,P<0.001);in the SSV-1 group,the preoperative GK was 81.1°±10.6°,and the value at 1-week post-operative was

关 键 词：SCHEUERMANN病 脊柱融合术 远端固定椎 矢状面稳定椎 远端交界性后凸 

分 类 号：R687.3[医药卫生—骨科学]