全脊椎截骨梯次矫形治疗重度脊柱角状后凸畸形

全脊椎截骨梯次矫形治疗重度脊柱角状后凸畸形

陈志明;马华松;吴继功;谭荣;赵福江;沙鑫;赵浩

【期刊名称】《实用骨科杂志》

【年(卷),期】2018(24)10

【摘要】Objective To evaluate the safety and clinical outcomes of posterior vertebral column resection (PVCR) combined with stepwise correction technique in the treatment of patients with severe angular kyphosis .Methods A prospective study was designed on patients .From January 2015 to December 2016 ,37 patients with severe angular ky-phosis underwent PVCR combined with stepwise correction

technique ,including16 males and 21 females with an aver-age age of 28 .6 years old (range 11～58 years).Relevant radiographic parameters were recorded pre-operatively ,post-operatively and at last follow-up ,included Cobb angle ,global kyphosis(GK) ,Trunk shift(TS) and sagittal vertical axis (SVA).The clinical outcomes were evaluated by MOS item short-form health survey (SF-36) ,visual analogue scale (VAS) and Oswestry disability index(ODI) ,while neurological function was evaluated by Frankel classification .Periop-erative complications were analyzed as well .Results The average operation time was (468 .9 ± 108 .3)min (range 312～723 min)with an average blood loss of (2 173 .7 ± 1 226 .6)mL (range 800～5 100 mL).The average follow-up time was 22 .5 months (12～40 months).The pre-operative averag e GK angle and Cobb angle were (124 ±

20 .4)°(range 91°～160°)and (87 .2 ± 45 .2)°(range 0°～156°).The post-operative average GK angle and Cobb angle were (46 .8 ± 21 .5)° (range 10°～120°)and (49 .1 ± 26 .9)°(range 0°～109°).The correction rate of GK angle and Cobb angle were 62 .3% and 45 .2%,respectively .At last follow-up ,no significant loss of correction was observed in the GK angle and Cobb’s angle. The pre-operative and post-operative TS were (38 .6 ±

17 .2)mm ,(11 .5 ± 11 .2)mm ,respectively ,SVA decre ased from pre-operative (33 .5 ± 11 .4)mm to (9 .6 ± 7 .2)mm post-operatively ,significant improvement of TS and SVA were ob-served .In addition ,compared with SF-36 ,VAS ,ODI values in pre-operation ,the values in both post-operation and the last follow-up have significant improvement .The incidence of perioperative complications was 37 .8%(n＝14)including complete paralysis (n＝1) ,transient neurological deficit (n＝3) ,hemothorax (n＝2) ,poor wound healing (n＝3) ,the digestive system complications (n＝3) ,screw

pull-out (n＝1)and screw cap dislodgement(n＝1).Conclusion Posteri-or vertebral column resection combined with stepwise correction technique can achieve satisfactory correction for severe angular

kyphosis .However ,more blood loss ,longer operative time needed in these procedures ,and high incidence of perioperative complications must be attentioned .%目的评价后路全脊椎截骨梯次矫形治疗重度脊柱角状后凸畸形的安全性和有效性.方法 2015年1月至2016年12月,前瞻性采取后路全脊椎截骨梯次矫形技术治疗重度脊柱角状后凸畸形患者37例,男16例,女21例;年龄11～

58岁,平均28 .6岁.所有入选患者均于手术前、后及末次随访时测量后凸Cobb角、侧凸Cobb角、冠状位躯干偏移(trunk shift ,TS)和矢状面平衡(sagittal vertical