脊柱后路分期矫形治疗重度脊柱侧后凸畸形的疗效  

Efficacy of posterior staged correction in the treatment of severe kyphoscoliosis

作　　者：李崟坤 史本龙[1] 刘臻[1] 毛赛虎[1] 乔军[1] 朱泽章[1] 邱勇[1] Li Yinkun;Shi Benlong;Liu Zhen;Mao Saihu;Qiao Jun;Zhu Zezhang;Qiu Yong(Division of Spine Surgery,Department of Orthopaedic Surgery,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》2023年第17期1146-1154,共9页Chinese Journal of Orthopaedics

基　　金：江苏省临床医学中心(YXZXA2016009)。

摘　　要：目的分析脊柱后路分期矫形治疗重度脊柱侧后凸畸形的疗效。方法回顾性分析2010年1月至2020年1月在南京大学医学院附属鼓楼医院采用一期后路Ponte截骨松解置钉+Halo-股骨髁上牵引、二期后路矫形治疗重度脊柱侧后凸畸形患者61例,男23例、女38例,年龄22.0(18.0,25.5)岁。病因包括特发性26例、先天性17例、神经肌源性16例、马方综合征伴脊柱侧后凸2例,胸弯49例、胸腰弯3例、胸腰双弯9例,顶椎位于T5水平1例、T7水平2例、T8水平9例、T9水平15例、T10水平23例、T11水平8例、T12水平1例、L1水平2例,主弯柔韧性为13.5%±8.6%。测量术前、牵引后、术后即刻、末次随访时的主弯侧凸Cobb角、最大后凸Cobb角、冠状面平衡(coronal trunk shift,CTS)、矢状面平衡(sagittal vertical axis,SVA)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)等参数,采用健康调查简表(the MOS item short form health survey,SF)-36评估生活质量,记录围手术期及随访期间的并发症。结果61例患者均获得随访,随访时间25.0(24.0,26.5)个月。术前主弯侧凸Cobb角和最大后凸Cobb角分别为121.4°±13.9°、86.8°±20.0°,后路松解牵引后分别为94.1°±18.7°、66.9°±15.3°,二期后路上棒矫形术后即刻分别为78.5°±20.3°、54.7°±13.6°,末次随访时分别为79.5°±20.1°、53.2°±11.3°,手术前后差异均有统计学意义(F=210.54,P<0.001;F=93.74,P<0.001),末次随访与术后即刻的差异均无统计学意义(P>0.05)。末次随访时SVA、TK、LL、PI、PT、SS与术后即刻相比均无明显矫正丢失(P>0.05)。术前CTS为(17.1±9.8)mm、术后即刻为(17.5±11.4)mm、末次随访时为11.1(5.9,23.3)mm,差异有统计学意义(χ^(2)=6.70,P=0.035);末次随访与术后即刻的差异有统计学意义(P=0.032)。末次随访时,SF-36量表中生理机能为80.0(75.0,85Objective To analyze the efficacy of posterior staged correction in the treatment of severe kyphoscoliosis.Methods Retrospective analysis was conducted on 61 patients with severe kyphoscoliosis who underwent one-stage posterior Ponte osteotomy followed by Halo-femoral traction and two-stage posterior correction in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School between January 2010 and January 2020.There were 23 males and 38 females with an average age of 22.0(18.0,25.5)years.The etiologies were idiopathic in 26 cases,congenital in 17 cases,neuromuscular in 16 cases and Marfan syndrome with kyphoscoliosis in 2 cases.The curves were thoracic in 49 cases,thoracolumbar in 3 cases and double major in 9 cases.The apical vertebrae were T5 level in 1 case,T7 level in 2 cases,T8 level in 9 cases,T9 level in 15 cases,T10 level in 23 cases,T11 level in 8 cases,T12 level in 1 case,and L1 level in 2 cases.The flexibility of main curve was 13.5%±8.6%.The Cobb angle of main curve,global kyphosis(GK),coronal trunk shift(CTS),sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),and sacral slope(SS)were assessed at pre-operation,post-traction,post-operation and the last follow-up.The quality of life was evaluated using the MOS item short form health survey(SF)-36 questionnaire,and the complications during peri-operation and long-term follow-up were recorded.Results All 61 patients were followed up for 25.0(24.0,26.5)months.The Cobb angle of main curve and GK were 121.4°±13.9°and 86.8°±20.0°at pre-operation,94.1°±18.7°and 66.9°±15.3°at post-traction,78.5°±20.3°and 54.7°±13.6°at post-operation and 79.5°±20.1°and 53.2°±11.3°at the last follow-up,respectively.The differences were statistically significant(F=210.54,P<0.001;F=93.74,P<0.001).There was no significant difference between the last follow-up and post-operation(P>0.05).There was no significant correction loss of SVA,TK,LL,PI,PT or SS at the last follow-up wh

关 键 词：脊柱侧凸 矫形外科手术 截骨术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]