后路顶椎区全椎间隙松解联合后柱截骨术治疗僵硬性脊柱侧凸
Posterior apical total intervertebral release combined with posterior column osteotomy for the treatment of rigid scoliosis
朱丰照 1张亚庆 1冯陈诚 1初同伟 1李长青 1周跃 1黄博1
作者信息
- 1. 陆军军医大学第二附属医院(重庆新桥医院)骨科,重庆 400037
- 折叠
摘要
目的 探讨后路顶椎区全椎间隙松解(intervertebral release,IVR)联合后柱截骨术(posterior column osteoto-my,PCO)治疗僵硬性脊柱侧凸的安全性和有效性.方法 回顾性分析2017年7月至2023年9月接受后路顶椎区多节段全IVR联合PCO治疗27例僵硬性脊柱侧凸畸形患者的临床与影像学资料,男10例、女17例,年龄(19.3±8.8)岁(范围11～48岁).特发性脊柱侧凸16例、神经肌肉型脊柱侧凸7例、先天性脊柱侧凸1例、马方综合征伴脊柱侧凸1例、神经纤维瘤病伴脊柱侧凸1例及成骨不全伴脊柱侧凸1例.术前冠状面主弯Cobb角为75.4°±13.7°(范围58.7°～110.2°),主弯柔韧性为15.7％±4.7％(范围2.5％～24.3％).术前CT提示顶椎区凸侧和凹侧IVR通道面积分别为(128.1±23.3)mm2和(89.5± 18.6)mm2,凸侧IVR通道面积明显高于凹侧IVR通道面积.结果 27例患者手术均顺利完成,顶椎区(3.4±0.7)个节段进行全IVR,术中Smith-Petersen截骨和Ponte截骨分别为(2.7±0.7)个节段和(4.9±1.1)个节段,固定融合(11.2±2.0)个节段.手术时间为(7.5±0.9)h(范围6.0～9.8h),估计失血量为(1 103.7±845.1)ml(范围300～4 500ml).随访时间为(20.0±14.2)个月(范围5～56个月).术前、术后1周和末次随访时主弯冠状面Cobb角分别为75.4°±13.7°、18.2°±6.5°和18.6°±6.5°,末次随访的矫正率为75.7％±5.3％.伴有胸腰椎后凸畸形13例,术前、术后1周和末次随访时主弯后凸Cobb角分别为47.2°± 4.7°、22.8°±9.1°和23.8°±8.9°,末次随访矫正率为49.5％±18.9％.IVR 区域的椎体轴向旋转度(axial vertebral rotation,AVR)术前为24.6°±7.6°,术后矫正至11.6°±5.6°,矫正率为54.0％±11.3％.术后冠状面主弯Cobb角、矢状位后凸Cobb角和AVR均较术前改善(P＜0.001).术后4例发生胸腔积液、1例发生肺部感染,经过保守治疗痊愈.1例患者术后2个月出现切口感染,通过清创手术后切口愈合.2例患者术后6个月内出现近端交界性后凸,1例接受翻修手术、另1例采用支具治疗.结论 后路顶椎区多节段全IVR联合PCO是一种安全、有效治疗僵硬性脊柱侧凸的手术方法.传统PCO松解效果不佳时建议采用全IVR技术作为补充,以实现更好的脊柱单元松解.
Abstract
Objective To investigate the safety and efficacy of posterior apical total intervertebral release(IVR)com-bined with posterior column osteotomy(PCO)in the treatment of rigid scoliosis.Methods This study retrospectively analyzed the clinical and radiographic data of 27 patients with rigid scoliosis who underwent posterior total IVR combined with PCO in the api-cal region from July 2017 to September 2023.There were 10 males and 17 females with an age of 19.3±8.8 years(range 11-48 years).Among them,there were 16 cases of idiopathic scoliosis,7 cases of neuromuscular scoliosis,1 case of congenital scoliosis,1 case of Marfan syndrome with scoliosis,1 case of neurofibromatosis with scoliosis,and 1 case of osteogenesis imperfecta with sco-liosis.The mean Cobb angle of the main curve was 75.4°±13.7°(range 58.7°-110.2°)preoperatively.The mean flexibility of the main curvature is 15.7％±4.7％(range 2.5％-24.3％).Preoperative computer tomography showed that the area of the IVR channel in the convex and concave side of the apical region was 128.1±23.3 mm2 and 89.5±18.6 mm2,respectively.The area of the convex IVR was significantly higher than that of the concave IVR.Results All 27 patients underwent surgery successfully.Total IVR was performed at an average of 3.4±0.7 levels in the apical region.SPO and Ponte osteotomy were performed at 2.7±0.7 and 4.9±1.1 levels,respectively.The mean fusion segment is 11.2±2.0.The operation time,estimated blood loss,and follow-up time were 7.5±0.9 hours(range 6.0-9.8 hours),1 103.7±845.1 ml(range 300-4 500 ml),and 20.0±14.2 months(range 5-56 months),respectively.The preoperative,postoperative,and final follow-up's mean coronal Cobb angles of the main curve were 75.4°±13.7°,18.2°±6.5° and 18.6°±6.5°,respectively.The mean correction rate was 75.7％±5.3％.In cases of thoracolumbar kyphosis,the preoperative,postoperative,and final follow-up mean sagittal Cobb angles were 47.2°±4.7°,22.8°±9.1° and 23.8°±8.9°,respectively.The mean correction rate was 49.5％±18.9％.The mean axial vertebral rotation(AVR)in the IVR re-gion was 24.6°±7.6° preoperatively and was corrected to 11.6°±5.6° postoperatively.The mean correction rate for AVR was 54.0％±11.3％.The coronal,sagittal Cobb angles and AVR postoperatively were significantly lower than those preoperatively(P＜0.001).This case series reported 4 cases of postoperative pleural effusion and 1 case of pulmonary infection,and all of them were cured through conservative treatment.One patient developed incision infection 2 months postoperatively and recov-ered through debridement surgery.Two patients had proximal junctional kyphosis,one of them underwent revision surgery,and another case was treated with braces.Conclusion Posterior multi-segment total IVR combined with PCO is a safe and effective surgical procedure for the treatment of rigid scoliosis.The procedure of total IVR was recommended as a supplement for better re-lease of the rigid spine when traditional release methods are not effective.
关键词
胸椎/腰椎/脊柱侧凸/椎间盘切除术/截骨术/椎间隙松解Key words
Thoracic vertebrae/Lumbar vertebrae/Scoliosis/Diskectomy/Osteotomy/Intervertebral release引用本文复制引用
出版年
2024
NETL
NSTL
万方数据