中华骨科杂志2024，Vol.44Issue(8) ：569-577.DOI:10.3760/cma.j.cn121113-20231219-00406

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 typeⅠ neurofibromatosis associated with kyphoscoliosis

李松 朱泽章 周杰 毛赛虎 朱奕同 刘臻 史本龙 孙旭 乔军 王斌 俞杨 邱勇
中华骨科杂志2024，Vol.44Issue(8) ：569-577.DOI:10.3760/cma.j.cn121113-20231219-00406
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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 typeⅠ neurofibromatosis associated with kyphoscoliosis

李松 1朱泽章 1周杰 1毛赛虎 1朱奕同 1刘臻 1史本龙 1孙旭 1乔军 1王斌 1俞杨 1邱勇1
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作者信息

  • 1. 南京大学医学院附属鼓楼医院骨科脊柱外科,南京 210008
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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 neurofibroma-tosis 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80％(8/10),高于后柱截骨组的27％(20/74),差异有统计学意义(x2=11.124,P=0.002).三柱截骨组置钉和钩的密度为72.0％±11.3％,高于后柱截骨组的61.4％±14.6％,差异有统计学意义(t=2.173,P=0.033).后柱截骨组总体并发症发生率为12％(9/74),三柱截骨组为20％(2/10),差异无统计学意义(P=0.613).结论 三柱截骨术用于矫正成人DKS-NF1患者的侧后凸畸形,而后柱截骨术主要用于年轻患者.多数患者采用单纯后路手术行后柱截骨或结合前路补充性融合即可达到矫形目的.对严重侧后凸畸形患者,术前Halo重力牵引有助于术中畸形的进一步矫正.

Abstract

Objective To compare the clinical outcomes between three-column osteotomy and posterior-column osteoto-my 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 osteoto-my 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 dur-ing the follow-up.The surgical efficacy was also compared based on the spinal correction and complications(such as cerebro-spinal fluid leakage,pneumothorax,rod breakage,etc.).Results The posterior column osteotomy group consisted of 74 pa-tients 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 osteoto-my group(26/74 vs.0,P=0.027).The apex of kyphosis in the three-column osteotomy group mainly located in the thoracolum-bar 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).Af-ter 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°±25.5°,respectively(t=3.016,P=0.003).The Cobb angle of the main curve was corrected from preoperative 83.0°± 29.0° and 66.3°±17.7°(t=1.766,P=0.081)to postoperative 50.6°±20.8° and 40.8°±15.6°(t=1.436,P=0.155),with correction rates of 38.3％±16.6％and 39.3％±12.7％(t=0.191,P=0.849),respectively.At the last follow-up,they were maintained at 52.3°±20.5° and 43.1°±18.2°,respectively(t=1.339,P=0.185).The proportion of multi-rod system application and screw densi-ty in three column osteotomy group was significantly higher than that in posterior column osteotomy group(8/10 vs.20/74,P=0.002;72.0％±11.3％vs.61.4％±14.6％,t=2.173,P=0.033).The incidence of complications in the two groups was 12.2％(pos-terior column osteotomy group,9/74)and 20％(three column osteotomy group,2/10),respectively,with no statistically signifi-cant difference(P=0.613).Conclusion Three-column osteotomy is mainly used to treat adult kyphosis in DKS-NF1 patients.While the posterior column osteotomy methods were mainly applied in young patients.Most patients can achieve the purpose of de-formity correction by posterior column osteotomy alone or combined with anterior complementary fusion.For patients with severe kyphosis,preoperative Halo gravity traction can help to further correct the intraoperative deformities.

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

Key words

Neurofibromatosis 1/Scoliosis/Kyphosis/Osteotomy/Treatment outcome

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基金项目

江苏省骨科医学创新中心项目(CXZX202214)

南京鼓楼医院新技术发展项目(XJSFZLX202108)

出版年

2024
中华骨科杂志
中华医学会

中华骨科杂志

CSTPCDCSCD北大核心
影响因子：2.137
ISSN：0253-2352
参考文献量22
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