单纯后路截骨矫形治疗僵硬性颈椎畸形  

Single posterior osteotomy for the treatment of rigid cervical spine deformities

作　　者：蔡晓宇 徐韬[1] 买尔旦·买买提[1] 曹锐[1] 荀传辉[1] 梁卫东[1] 张健[1] 邓强[1] 甫拉提·买买提[1] 盛军[1] 王婷[1] 盛伟斌[1] Cai Xiaoyu;Xu Tao;Maierdan·Maimaiti;Cao Rui;Xun Chuanhui;Liang Weidong;Zhang Jian;Deng Qiang;Pulati·Maimaiti;Sheng Jun;Wang Ting;Sheng Weibin(Department of Spine Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urmuqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054

出　　处：《中华骨科杂志》2024年第19期1265-1272,共8页Chinese Journal of Orthopaedics

基　　金：新疆维吾尔自治区自然科学基金重点项目(2022D01D58);新疆维吾尔自治区自然科学青年科学项目(2022D01C745);新疆维吾尔自治区"天池英才"领军人才项目(2023.55);中央引导地方科技发展资金项目(ZYYD2024ZY12)。

摘　　要：目的探讨单纯后路截骨矫形治疗僵硬性颈椎畸形的安全性和有效性、手术适应证及关键技术。方法回顾性分析2012年6月至2023年6月新疆医科大学第一附属医院采取单纯后路截骨矫形治疗僵硬性颈椎畸形的患者9例,男4例、女5例;年龄(19.8±27.2)岁(范围7~48岁)。先天性颈椎畸形5例,治愈型结核3例,医源性颈椎畸形1例。测量C1,2角、颈椎前凸角(cervical lordosis,CL)、颈椎侧凸角(structural scoliosis angle,SSA)、颈椎后凸角(structural kyphosis angle,SKA)、头部倾斜角(head tilt,HT)、颈椎矢状偏移距离(C2~C7 sagittal vertical axis,CSVA)、躯干矢状偏移距离(sagittal vertical axis,SVA)、冠状面偏移距离(coronal balance distance,CBD)、T1倾斜角(T1 Slope,T1S)及T1S与颈椎前凸角的差值(T1S-CL)。采用颈椎功能障碍指数(neck disability index,NDI)、疼痛视觉模拟评分(visual analogue scale,VAS)及脊柱侧凸研究学会-22(Scoliosis Research Society-22,SRS-22)简明量表评估颈椎畸形患者的生活质量。结果手术时间(273.9±76.1)min,出血量(472.2±128.8)ml。9例患者均获随访,随访时间(45.2±41.8)个月(范围12~116个月)。单节段截骨7例(C3、C6、C7各1例,C54例),双节段截骨2例(C2和C7,C3和C4)。经椎弓根截骨4节段,全脊椎截骨7节段。上固定椎(upper instrumented vertebrae,UIV)位于枕骨1例、颈椎8例,下固定椎(lower instrumented vertebrae,LIV)位于上胸椎6例、颈椎3例,其中UIV和LIV均位于颈椎2例。融合固定节段(7.6±4.4)个(范围2~12个)。术后(8.8±3.2)个月(范围6~12个月)患者均获得良好的植骨融合。9例患者术前CL、SSA、SKA、HT、CBD分别为19.8°(17.2°,30.5°)、27.4°(23.3°,30.4°)、28.4°(25.6°,30.1°)、9.0°(6.2°,12.3°)、18.5(12.3,23.6)mm;术后改善至-11.1°(-8.8°,-14.4)、1.3°(0.8°,1.6°)、-11.1°(-8.6°,-14.5°)、1.6°(0.5°,2.2°)、9.4(4.8,13.5)mm;末次随访时分别为-11.0°(-8.8°,-14.3°)、1.2°(0.8°,1.5°)、-11.0°(-8.6°,-14.3°)、1.Objective To evaluate the safety and effectiveness of single posterior osteotomy in the correction of rigid cervical spine deformities(CSD)and to explore the indications and key surgical techniques involved.Methods A retrospective analysis was conducted on the clinical data of 9 patients with rigid CSD who underwent single posterior osteotomy correction between June 2012 and June 2023 in the Department of Spine Surgery at the First Affiliated Hospital of Xinjiang Medical University.The cohort comprised 4 males and 5 females,with a mean age of 19.8±27.2 years(range,7-48 years).Among these,5 cases were congenital CSD,3 were post-tuberculosis deformities,and 1 was iatrogenic.Various coronal and sagittal alignment parameters were measured,including C,2 angle,cervical lordosis(CL),structural scoliosis angle(SSA),structural kyphosis angle(SKA),head tilt(HT),C2-C sagttal vertical axis(CSVA),sagittal vertical axis(SVA),coronal balance distance(CBD),T,slope(T,S),and the difference between T,tilt and cervical lordosis(TS-CL).Clinical outcomes were assessed using the neck disability index(NDI),visual analogue scale(VAS),and Scoliosis Research Society-22questionnaire(SRS-22).ResultsThe average operation time was 273.9±76.1 min,with an average blood loss of 472.2±128.8 ml.All 9 patients were followed up for an average of 45.2±41.8 months(range,12-116 months).A total of 7 patients underwent single-segment osteotomies(C3,C,and C:1 case each;Cs:4 cases),and 2 patients underwent double-segment osteotomies(C:and C7,Csand C4).Four cases involved pedicle subtraction osteotomy(PSO),while 7 cases required vertebral column resection.The upper instrumented vertebra(UIV)was located at the occiput in 1 case and in the cervical spine in 8 cases.The lower instrumented vertebra(LIV)was located in the upper thoracic spine in 6 cases and in the cervical spine in 3 cases,with 2 of the latter cases having both UIV and LIV in the cervical spine.The average number of fused segments was 7.6±4.4 segments(range,2-12 segments).All patients achiev

关 键 词：颈椎 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]