后路微创矫形术治疗伴严重骨盆倾斜的儿童脊髓损伤后麻痹性脊柱侧凸  

Posterior minimally invasive surgery for treating paralytic scoliosis with pelvic obliquity in children following spinal cord injury

作　　者：陈溢 秦晓东[1] 何中 刘臻[1] 毛赛虎[1] 史本龙[1] 邱勇[1] 朱泽章[1] Chen Yi;Qin Xiaodong;He Zhong;Liu Zhen;Mao Saihu;Shi benlong;Qiu Yong;Zhu Zezhang(Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nangjing 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》2025年第2期67-76,共10页Chinese Journal of Orthopaedics

基　　金：南京鼓楼医院临床研究专项基金(2022-LCYJ-PY-39)。

摘　　要：目的探讨脊柱后路微创矫形术(minimally invasive surgery,MIS)与传统后路脊柱融合手术(posterior spinal fusion,PSF)治疗伴骨盆倾斜的儿童脊髓损伤后麻痹性脊柱侧凸的临床疗效。方法回顾性分析2017年1月至2023年6月于南京大学医学院附属鼓楼医院接受手术治疗的伴骨盆倾斜的25例麻痹性脊柱侧凸患者资料,男4例、女21例,年龄为(12.3±2.8)岁(范围9~14岁)。按手术方式分为MIS组(12例)和PSF组(13例)。于术前、术后及末次随访时测量影像学参数,并记录手术时间,术中出血量、术中输血量、住院时间、住院总费用及并发症。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)中文版评估患者满意度及疗效。结果MIS组与PSF组年龄、性别、Risser征、术前侧凸Cobb角、骨盆倾斜角、局部后凸角比较差异均无统计学意义(P>0.05)。MIS组手术时间为(176±30)min、术中出血量为(300±70)ml、输血量为(280±175)ml、住院总费用为(8.78±1.33)万元,低于PSF组的(280±91)min、(1433±116)ml、(1351±996)ml、(14.84±2.61)万元,差异均有统计学意义(t=3.789,P=0.001;t=29.328,P<0.001;t=3.667,P=0.001;t=7.271,P<0.001)。MIS组术前、术后及末次随访时侧凸Cobb角分别为79.11°±6.74°、35.86°±4.98°和36.27°±4.84°,骨盆倾斜角分别为24.79°±5.58°、9.18°±3.32°和8.79°±2.94°,局部后凸角分别为38.84°±4.18°、12.96°±4.87°和11.43°±6.08°,术后、末次随访与术前比较均降低,手术前后的差异均有统计学意义(P<0.05);PSF组患者术前、术后及末次随访时侧凸Cobb角分别为82.06°±9.26°、34.75°±5.14°和35.15°±5.04°,骨盆倾斜角分别为26.60°±6.21°、10.12°±3.21°和9.91°±2.97°,局部后凸角分别为40.92°±7.04°、10.92°±7.26°和14.02°±5.58°,手术前后的差异均有统计学意义(P<0.05)。两组患者末次随访时侧凸矫正均无明显丢失,术后与末次随访时的差异均�ObjectiveTo compare the clinical efficacy of Minimally Invasive Surgery(MIS)and traditional Posterior Spinal Fusion(PSF)in treating children with paralytic scoliosis with pelvic obliquity(PSPO)following spinal cord injury.MethodsA retrospective analysis was conducted on the data of 25 patients with PSPO who underwent surgical treatment at the Drum Tower Hospital affiliated with Nanjing University Medical School from January 2017 to June 2023.The cohort included 4 males and 21 females,aged 12.3±2.8 years(range 9-14 years).Patients were divided into the MIS group(12 cases)and the PSF group(13 cases).Radiological parameters were measured preoperatively,postoperatively,and at the last follow-up.Surgical time,intraoperative blood loss,intraoperative blood transfusion volume,length of hospital stay,total hospitalization costs,and complications were recorded.The Scoliosis Research Society questionnaires-22(SRS-22)Chinese version were used to assess patient satisfaction and efficacy.ResultsThere were no statistically significant differences between the MIS and PSF groups in age,gender,Risser sign,preoperative Cobb angle for scoliosis,pelvic tilt angle,or local kyphosis angle(P>0.05).The MIS group demonstrated surgical time of 176±30 minutes,intraoperative blood loss of 300±70 ml,blood transfusion volume of 280±175 ml,and total hospitalization costs of 87'800±13'300 yuan,all of which were lower than PSF group,with values of 280±91 minutes,1'433±116 ml,1'351±996 ml,and 14'8400±26'100 yuan,respectively.These differences were statistically significant(t=3.789,P=0.001;t=29.328,P<0.001;t=3.667,P=0.001;t=7.271,P<0.001).In the MIS group,preoperative,postoperative,and last follow-up Cobb angles were 79.11°±6.74°,35.86°±4.98°,and 36.27°±4.84°respectively;pelvic tilt angles were 24.79°±5.58°,9.18°±3.32°,and 8.79°±2.94°;local kyphosis angles were 38.84°±4.18°,12.96°±4.87°,and 11.43°±6.08°,respectively.Postoperative and last follow-up angles were significantly reduced compared to preoperative value

关 键 词：脊髓损伤 脊柱侧凸 最小侵入性外科手术 疗效比较研究 

分 类 号：R68[医药卫生—骨科学]