环周松解及TLIF矫正旋转半脱位对退变性脊柱侧凸术后冠状面失平衡的影响  

The effect of correcting rotational subluxation through circumferential fusion and transforaminal lumbar interbody fusion on postoperative coronal plane imbalance in degenerative scoliosis

作　　者：鲍虹达 舒诗斌 张鑫[1] 刘臻[1] 钱邦平[1] 王斌[1] 俞杨[1] 邱勇[1] 朱泽章[1] Bao Hongda;Shu Shibin;Zhang Xin;Liu Zhen;Qian Bangping;Wang Bin;Yu Yang;Qiu Yong;Zhu Zezhang(Division of Spine Surgery,Department of Orthopaedics,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,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》2025年第4期215-221,共7页Chinese Journal of Orthopaedics

基　　金：江苏省医学科研专项基金(M2022003)。

摘　　要：目的探讨环周松解及经椎间孔椎间融合术(transforaminal lumbar interbody fusion,TLIF)矫正旋转半脱位对退变性脊柱侧凸术后冠状面失平衡的影响。方法回顾性分析2017年6月至2021年6月在南京鼓楼医院接受一期后路多节段后柱截骨术(posterior column osteotomy,PCO)矫形内固定的108例南京分型A型的退变性脊柱侧凸患者的资料。根据术前是否存在旋转半脱位分为旋转半脱位组和无旋转半脱位组。旋转半脱位组60例,男8例、女52例,年龄(63.7±5.5)岁(范围56~75岁);无旋转半脱位组48例,男5例、女43例,年龄(64.4±5.2)岁(范围53~72岁)。旋转半脱位组再根据在旋转半脱位节段采用的手术方式分组,采用TLIF治疗(TLIF组)28例、采用PCO治疗(PCO组)32例。术前、术后和末次随访时摄全脊柱正侧位X线片,比较旋转半脱位组和无旋转半脱位组、TLIF组和PCO组患者的腰弯Cobb角、冠状面平衡(coronal balance distance,CBD)和腰骶弯Cobb角(Cobb-Fra角)的差异。结果108例患者手术时间为(235±47)min(范围200~310 min),术中出血量为(950±355)ml(范围700~2400)ml。旋转半脱位组融合节段为(7.6±2.1)个(范围5~11个)、无旋转半脱位组为(7.4±2.0)个(范围5~10个)。旋转半脱位组术后出现冠状面C型失平衡的比例为13%(8/60),高于无旋转半脱位组的2%(1/48)。术后即刻和末次随访时旋转半脱位组腰弯Cobb角、CBD和Cobb-Fra分别为20.60°±10.73°和20.33°±10.92°、(22.53±16.45)mm和(18.53±17.31)mm、13.14°±4.40°和11.23°±4.92°,高于无旋转半脱位组的13.92°±7.02°和12.92°±6.64°、(18.62±17.44)mm和(8.83±8.95)mm、11.91°±3.03°和9.52°±3.30°,差异均有统计学意义(P<0.05)。在旋转半脱位组患者中,TLIF组术后出现新发冠状面失平衡的概率为4%(1/28),低于PCO组的22%(7/32),差异有统计学意义(χ^(2)=4.330,P=0.037);术后即刻和末次随访时PCO组腰弯Cobb角、CBD和Cobb-Fra分别为25.63°±11.00°和25.13°±11.04°、(27.Objective To investigate the impact of correcting rotational subluxation through circumferential fusion and transforaminal lumbar interbody fusion(TLIF)on postoperative coronal plane imbalance in degenerative scoliosis.MethodsA retrospective analysis was conducted on the data of 108 patients with type A degenerative scoliosis in the Nanjing classification who underwent primary multi-segment posterior column osteotomy(PCO)with deformity correction and internal fixation at Nanjing Gulou Hospital from June 2017 to June 2021.Patients were divided into two groups based on the presence of preoperative rotational subluxation:the rotational subluxation group and the non-rotational subluxation group.The rotational subluxation group consisted of 60 patients,with 8 males and 52 females,aged 63.7±5.5 years(range,56-75 years).The non-rotational subluxation group included 48 patients,with 5 males and 43 females,aged 64.4±5.2 years(range,53-72 years).Within the rotational subluxation group,depending on whether TLIF was performed on the rotational subluxation segment,they were further categorized into the TLIF group and the PCO group.The TLIF group comprised 28 patients,while the PCO group had 32 patients.Full-spine anteroposterior and lateral X-rays were taken preoperatively,postoperatively,and at the last follow-up to measure coronal balance types and radiographic parameters.The differences in the lumbar Cobb angle,coronal balance distance(CBD),and the Cobb angle of the lumbosacral curve(Cobb-Fra angle)were compared between the rotational subluxation group and the non-rotational subluxation group,as well as between the TLIF group and the PCO group.ResultsThe average surgery duration ranged from 200 to 310 min,with a mean of 235±47 min.The intraoperative blood loss ranged from 700 to 2,400 ml,with an average of 950±355 ml.The number of fused segments in the rotational subluxation group was 7.6±2.1,ranging from 5 to 11 segments,while in the non-rotational subluxation group,it was 7.4±2.0,ranging from 5 to 10 segments.Posto

关 键 词：脊柱侧凸 椎间盘退行性变 脱位 截骨术 冠状面平衡 

分 类 号：R687.3[医药卫生—骨科学]