三柱与后柱截骨矫正Ⅰ型神经纤维瘤病伴萎缩性脊柱侧后凸畸形的疗效比较  

Comparison of surgical outcomes between three-column osteotomy and posterior column osteotomy for correcting type I neurofibromatosis associated with kyphoscoliosis

作　　者：李松[1] 朱泽章[1] 周杰 毛赛虎[1] 朱奕同 刘臻[1] 史本龙[1] 孙旭[1] 乔军[1] 王斌[1] 俞杨[1] 邱勇[1] Li Song;Zhu Zezhang;Zhou Jie;Mao Saihu;Zhu Yitong;Liu Zhen;Shi Benlong;Sun Xu;Qiao Jun;Wang Bin;Yu Yang;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》2024年第8期569-577,共9页Chinese Journal of Orthopaedics

基　　金：江苏省骨科医学创新中心(CXZX202214);南京鼓楼医院新技术发展项目(XJSFZLX202108)。

摘　　要：目的比较Ⅰ型神经纤维瘤病伴萎缩性脊柱侧后凸畸形(dystrophic kyphoscoliosis secondary to neurofibromatosis type 1,DKS-NF1)患者矫形术中采用后柱截骨与三柱截骨的临床疗效。方法回顾性分析2000年6月至2021年9月南京鼓楼医院84例接受手术治疗的DKS-NF1患者的病历资料,男60例、女24例,年龄(17.7±6.9)岁(范围5~44岁),单弯50例、双弯18例、三弯16例,后凸位于胸段42例、胸腰段31例、腰段11例。接受单纯后路或前后联合入路手术,根据术中截骨方式分为后柱截骨组(74例)和三柱截骨组(10例)。比较两组患者手术前后及末次随访时的影像学参数(包括后凸Cobb角、侧凸Cobb角、冠状面平衡、矢状面平衡),根据手术前后及末次随访时的矫形情况及并发症发生情况评估临床疗效。结果后柱截骨组患者年龄(15.8±4.8)岁,小于三柱截骨组的(29.4±10.2)岁,差异有统计学意义(t=7.088,P<0.001);术前Halo重力牵引率为35%(26/74),三柱截骨组为0,差异有统计学意义(P=0.027)。三柱截骨组后凸顶椎均位于胸腰段和腰段,胸腰段和腰段的占比高于后柱截骨组(32/74),差异有统计学意义(P=0.001)。后柱截骨组和三柱截骨组术前后凸Cobb角分别为73.8°±20.9°和63.1°±21.4°,差异无统计学意义(t=1.506,P=0.136);术后分别矫正至43.1°±20.9°和21.1°±22.8°,组间差异有统计学意义(t=3.066,P=0.003);后柱截骨组矫正率为43.7%±19.6%,小于三柱截骨组的84.1%±78.7%,差异有统计学意义(t=3.677,P<0.001);末次随访时分别维持在46.5°±20.9°和24.6°±25.5°,差异有统计学意义(t=3.016,P=0.003)。后柱截骨组和三柱截骨组患者主弯Cobb角分别由术前83.0°±29.0°和66.3°±17.7°(t=1.766,P=0.081)矫正至术后50.6°±20.8°和40.8°±15.6°(t=1.436,P=0.155),矫正率分别为38.3%±16.6%和39.3%±12.7%(t=0.191,P=0.849),末次随访时分别维持在52.3°±20.5°和43.1°±18.2°(t=1.339,P=0.185)。三柱截骨组多棒系统的应用占比为80Objective To compare the clinical outcomes between three-column osteotomy and posterior-column osteotomy for correcting dystrophic kyphoscoliosis secondary to neurofibromatosis type 1(DKS-NF1).Methods ALL of 84 patients with DKS-NF1 were retrospectively analyzed,and the average age was 17.7±6.9 years.There were 50 cases with single curve,18 cases with double curves,and 16 cases with triple curves;kyphosis was found in 42 cases in the thoracic area,31 cases in the thoracolumbar area,and 11 cases in the lumbar area.The patients were divided into two groups:posterior column osteotomy group and three column osteotomy group based on surgical strategy.The radiographic parameters(including the magnitude of kyphosis,scoliosis,coronal balance distance,etc.)were compared between the two groups before and after surgery,and during the follow-up.The surgical efficacy was also compared based on the spinal correction and complications(such as cerebrospinal fluid leakage,pneumothorax,rod breakage,etc.).Results The posterior column osteotomy group consisted of 74 patients and the column osteotomy group consisted of 10 patients.The age of patients in the posterior column osteotomy group was significantly younger than that in the three-column osteotomy group(15.8±4.8 years vs.29.4±10.2 years,t=7.088,P<0.001),and the proportion of preoperative traction in this group was significantly higher than that in the three column osteotomy group(26/74 vs.0,P=0.027).The apex of kyphosis in the three-column osteotomy group mainly located in the thoracolumbar and lumbar area,significantly higher than that in the posterior column osteotomy group(10/10 vs.32/74,P=0.001).The magnitude of kyphosis in the two groups were 73.8°±20.9°and 63.1°±21.4°before surgery,respectively(t=1.506,P=0.136).After surgery,they were corrected to 43.1°±20.9°and 21.1°±22.8°,respectively(t=3.066,P=0.003),with correction rates of 43.7%±19.6%and 84.1%±78.7%,respectively(t=3.677,P<0.001).At the last follow-up,they were maintained at 46.5°±20.9°and 24.6°�

关 键 词：神经纤维瘤病1型 脊柱侧凸 脊柱后凸 截骨术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]