脊柱去松质骨截骨治疗僵硬性脊柱侧凸的有效性及安全性分析

Vertebral column decancellation for the management of rigid scoliosis： the effectiveness and safety analysis

目的 探讨脊柱去松质骨截骨（VCD）治疗僵硬性脊柱侧凸畸形的有效性及安全性.方法 回顾性分析2004年5月至2008年2月实施VCD的32例僵硬性脊柱侧凸畸形患者的临床资料.其中男性12例,女性20例;平均年龄18岁（10～56岁）.手术技术包括多节段VCD,切除顶椎区域残留椎间盘,对脊柱侧凸畸形进行矫形并后路椎弓根钉内固定.随访时除行常规X线片检查外,部分病例采用CT三维重建技术对截骨部位融合情况进行评估.通过术前术后X线片对矫形效果进行评价,并对术中、术后并发症情况进行统计分析.结果 本组平均切除2.1个椎体,平均固定融合10.6个节段（范围：8～13个节段）.平均手术时间270 min（215～380 min）.术中平均出血1560 ml（范围：900～4800 ml）.4例患者出现手术并发症,其中出现一过性神经症状2例,脑脊液漏1例,硬膜外血肿1例.患者均获随访,随访时间24～48个月,平均31个月.术前冠状面Cobb角92°～138°,平均108°,术后矫正至32°～51°,平均42°;平均矫正率为61%.矢状面Cobb角术前平均82.0°,术后矫正至28.7°.所有患者截骨部位获得坚固融合,没有发现断钉断棒及内固定松动等并发症.结论 单纯后路VCD治疗僵硬性脊柱侧凸畸形安全有效.

Objective To explore the effectiveness and safety of vertebral column decancellation （VCD） for the management of rigid scoliosis. Methods From May 2004 to February 2008, 32 patients with rigid scoliosis underwent VCD were reviewed. There were 12 males and 20 females with an average age of 18 years （range, 10-56 years）. The operation techniques included multilevel vertebral body decancellation and residual intervertebral disc resection, followed by realignment and posterior correction with pedicle screws.The effectiveness was evaluated by preoperative and postoperative radiography and three-dimensional CT scan reconstruction at final follow-up. The intraoperative and postoperative complications of all patients were recorded. Results A mean of 2. 1 vertebrae were performed with VCD and a mean of 10. 6 vertebral levels were instrumented and fused （range, 8-13 vertebrae）. The mean duration of surgery was 270 minutes （range, 215-380 minutes）. The average intraoperative blood loss was 1560 ml （range, 900-4800 ml）.Complications were encountered in 4 patients. There were 2 cases with transient neurological deficits, 1 case with CSF leak, 1 case with epidural hematoma. The average time of follow-up was 31 months （range, 24-48 months）. The correction rate was 61% on the coronal plane （ from 108° to 42° ）, and the correction rate was 65% on the sagittal plane （from 82.0° to 28.7°）. All patients had solid fusion at osteotomy site, and no instrumentational failure and loosening were found over the follow up. Conclusion Single stage posterior VCD is an effective option to manage rigid scoliosis.