后路多节段Ponte截骨与经椎弓根椎体截骨矫形手术治疗胸腰型休门氏病后凸畸形的疗效分析  

Efficacy analysis of posterior multi-segment Ponte osteotomy and pedicle subtraction osteotomy in treating Scheuermann′s thoracolumbar kyphosis

作　　者：汪大伟 郭继东[1] 李利[1] 尹欣 杨亚锋 黄伟[1] 张子程 郑扬 王华东[1] WANG Dawei;GUO Jidong;LI Li(Department of Spine Surgery,Senior Department of Orthopedics,the Fourth Medical Center of PLA General Hospital,Beijing,100048,China)

机构地区：[1]解放军总医院第四医学中心骨科学部脊柱外科,北京市100048

出　　处：《中国脊柱脊髓杂志》2023年第8期673-681,共9页Chinese Journal of Spine and Spinal Cord

基　　金：军委后勤保障部卫生局面上项目(军后综[2019]576号)。

摘　　要：目的:对比分析后路多节段Ponte截骨术(multi-segment Ponte osteotomy)与经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO)治疗胸腰型休门氏病后凸畸形(Scheuermann's thoracolumbar kyphosis,STLK)的疗效.方法:回顾性分析2011年12月~2021年6月于我院诊断为休门氏病后凸畸形、分型为胸腰型(顶椎位置低于T10椎体)并行多节段Ponte截骨或PSO矫形内固定手术患者的资料,共纳入18例患者,随访26~55个月(35.83±8.41个月),Ponte组共10例患者,均行3节段截骨,PSO组共8例患者,均为单节段截骨.记录两组患者的年龄、性别、身体质量指数(body mass index,BMI)、顶椎位置、病变节段、固定节段、手术时间、术中出血量、术后引流量、住院天数、随访时间及手术相关并发症;记录两组患者术前、术后1周及末次随访时的疼痛视觉模拟评分(visual analogue scale,VAS),术前及末次随访时的Oswestry功能障碍指数(Oswestry dis-ability index,ODI)及SRS-22(Scoliosis Research Society-22)问卷评分;测量术前、术后1周及末次随访时的胸椎后凸角(thoracic kyphosis,TK)、整体后凸Cobb角(global kyphosis,GK)、T1骨盆角(T1 pelvic angle,TPA)、T1-L1骨盆角(T1-L1 pelvic angle,TLPA)、腰椎前凸角(lumbar lordosis,LL)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、骨盆入射角(pelvic incidence,PI)、PI-LL及矢状面轴向距离(sagittal vertical axis,SVA),计算GK矫正率、GK矫正丢失率,比较两组一般资料、手术相关资料、影像学参数及功能评分之间的差异.结果:所有患者均手术顺利,术后Ponte组出现2例浅表手术部位感染,PSO组出现1例,均经伤口换药处理后二期愈合,无其他并发症发生.两组的年龄、性别、BMI、顶椎位置分布、病变节段、固定节段及随访时间均无统计学差异(P>0.05);但Ponte组比PSO组手术时间及住院时间更短且其术中出血量及术后引流量更少(P<0.05).两组患者术后1周及末次随访时的VAObjectives:To compare and analyze the efficacies of posterior multi-segment Ponte osteotomy and pedicle subtraction osteotomy(PSO)in the treatment of Scheuermann′s thoracolumbar kyphosis(STLK).Methods:We retrospectively analyzed the data of patients with STLK(apex below T10)who underwent multi-segment Ponte osteotomy or PSO at our hospital from December 2011 to June 2021,and 18 patients were included with a mean follow-up of 35.83±8.41 months(26-55 months).10 out of the 18 patients were included in the Ponte group(three-segment osteotomy on average),and the other 8 were include in the PSO group(single-segment osteotomy).Data such as age,gender,body mass index(BMI),apical vertebra,lesion segments,surgical segments,operative time,intraoperative blood loss,postoperative drainage volume,length of hospital stay,follow-up period,and surgical complications of both groups of patients were recorded.The visual analogue scale(VAS)was compared between the two groups before operation,at 1 week post-operation and the final follow-up,the Oswestry disability index(ODI)and Scoliosis Research Society-22(SRS-22)patient questionnaire scores were compared between the two groups before operation and at the final follow-up.Thoracic kyphosis(TK),global kyphosis(GK),GK correction ratio,GK correction loss ratio,T1 pelvic angle(TPA),T1-L1 pelvic angle(TLPA)and lumbar lordosis(LL),pelvic tilt(PT),sacral slope(SS),pelvic incidence(PI),PI-LL and sagittal vertical axis(SVA)were measured and compared between the two groups before operation,at 1 week after operation and the final follow-up.Results:All the patients were successfully operated,with superficial surgical site infection occurred in 2 cases in Ponte group and 1 case in PSO group,and no other surgical complications.There were no statistically differences between the two groups in age,gender,BMI,apical vertebra,lesion segments,surgical segments and follow-up time(P>0.05);However,the operative time,intraoperative blood loss,and postoperative drainage were less and length of hospital st

关 键 词：休门氏病 后凸 Ponte截骨 经椎弓根椎体截骨 矫形 疗效 

分 类 号：R682.3[医药卫生—骨科学] R687.3[医药卫生—外科学]