后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形

Apical pedicle subtraction osteotomy in the treatment of severe rigid kyphoscoliosis： a preliminary report

目的评价后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形的安全性和早期临床治疗效果。方法回顾性分析12例行后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形患者的术前、术后及随访时的X光像，对侧凸Cobb角、后凸Cobb角、躯干平衡等进行测量和分析。复习手术记录和病历，记录围手术期并发症。结果本组患者12例，男4例，女8例，平均年龄20．1（9～57）岁，其中成人脊柱侧凸2例，先天性脊柱侧后凸畸形10例。平均随访9．2个月。融合固定节段平均12个节段。手术时间平均5．0h，术中出血量平均1517ml，回输自体血平均780ml，异体输血平均1109ml。手术前后主弯冠状面Cobb角分别为100．9°和48．8°，平均矫正率51．8％（P=0．000）。节段性后凸Cobb角分别为81．7°和42．2°，平均矫正率为49．8％（P=0．000）。随访时主弯冠状面Cobb角及节段性后凸Cobb角分别为50．7°和46．0°，矫形无明显丢失（P=0．763，P=0．698）。手术前、后及随访时冠状面躯干平衡分别为16．3、14．7和12．0mm，随访时仅1例发生冠状面躯干失平衡（22mm）。2例患者出现一过性的下肢单侧肢体麻木、无力，获完全恢复。所有患者均无脊髓损伤。结论后路顶点经椎弓根截骨术是矫正重度僵硬性脊柱侧后凸畸形的安全方法，早期结果令人满意。

Objective To evaluate the safety and efficacy of apical pedicle subtraction osteotomy （PSO） in the treatment of severe kyphoscoliosis. Methods The radiographic films of the 12 severe kyphoscoliosis patients treated with apical pedicle subtraction osteotomy were retrospectively reviewed, and the Cobb angles of the scoliosis and kyphosis and coronal trunk balance were measured and analyzed. Medical records and operation charts were reviewed to record any peri-operative complications. Results Twelve patients were included in this study, 4 males and 8 females, with an average age of 20. 1 years old. Of the 12 patients, 2 were adult kyphoscoliosis and 10 were congenital kyphoscoliosis. The mean follow-up time was 9. 2 months. The mean fusion levels were 12 segments and the mean operation time was 5.0 hours. The mean estimated blood loss during operation was 1517 ml and the mean autotransfusion and allotransfusion were 780 ml and 1109 ml, respectively. The mean preoperative and postoperative coronal Cobb angle of the main curve was 100. 9° and 48.8°, with an average correction rate of 51.8% （ P = 0. 000 ）. The mean preoperative and postoperative sagittal Cobb angle of the kyphosis was 81.7° and 42. 2°, with an average correction rate of 49. 8% （P = 0. 000）. At final follow-up, the mean Cobb angles of the scoliosis and kyphosis were 50. 7° and 46. 0°, respectively, and no obvious correction loss was found（ P = 0. 763, P = 0. 698）. The mean coronal trunk balance before, after surgery and at final follow-up was 16. 3 mm, 14.7 mm, and 12.0 mm, respectively. Only 1 patient had trunk shift greater than 20 mm at final follow-up. After operation, two patients suffered from transient numbness and weakness of the unilateral lower extremity with complete recovery in one week. No spinal cord injury occurred. Conclusions Apical pedicle subtraction osteotomy can be easily performed in the treatment of severe rigid kyphoscoliosis with satisfactory correction results and few neurologic complications.