经椎弓根截骨与非截骨技术治疗中重度脊柱侧后凸的临床研究

EFFECTIVENESS COMPARISON BETWEEN PEDICLE SUBTRACTION OSTEOTOMY AND NON-OSTEOTOMY TECHNIQUES IN TREATMENT OF MEDIUM-TO-SEVERE KYPHOSCOLIOSIS

目的探讨对于中重度脊柱侧后凸畸形,采用经椎弓根截骨(pedicle subtraction osteotomy,PSO)技术和非截骨技术治疗的临床效果。方法 2005年1月-2009年1月,对99例中重度脊柱侧后凸畸形患者分别采用PSO截骨(PSO截骨组,46例)和非截骨技术(非截骨组,53例)行后路矫形治疗。两组患者性别、年龄、术前主侧凸Cobb角、胸腰段后凸Cobb角等一般资料比较差异无统计学意义(P>0.05),有可比性。分别记录两组手术时间、出血量,术后测量脊柱主侧凸Cobb角、胸腰段后凸Cobb角,并计算侧凸和后凸矫正率以及末次随访的矫正率丢失。结果患者均顺利完成手术。PSO截骨组患者手术时间和出血量均多于非截骨组,比较差异有统计学意义(P<0.05)。所有患者均获随访,随访时间12～56个月,平均22.4个月。两组均未出现脊髓神经损伤,末次随访时均获得良好的骨性融合。两组患者术后2周及末次随访时的主侧凸Cobb角及胸腰段后凸Cobb角均较术前显著改善(P<0.05)。术后2个时间点的主侧凸Cobb角、矫正率两组间比较差异均无统计学意义(P>0.05);但PSO截骨组末次随访时的矫正率丢失明显小于非截骨组(P<0.05)。术后2个时间点的胸腰段后凸Cobb角、矫正率及矫正率丢失,PSO截骨组均优于非截骨组,差异有统计学意义(P<0.05)。结论对于中重度脊柱侧后凸畸形,PSO截骨技术较非截骨技术在冠状面侧凸的矫形方面无显著差异,但能够获得更好的脊柱矢状面后凸矫形效果;但PSO截骨的手术时间和出血量会显著增加。

Objective To evaluate the effectiveness of pedicle subtraction osteotomy（PSO） and non-osteotomy techniques in treatment of medium-to-severe kyphoscoliosis by retrospective studies.Methods Between January 2005 and January 2009,99 patients with medium-to-severe kyphoscoliosis were treated by PSO（PSO group,n=46） and non-osteotomy technique（non-osteotomy group,n=53） separately.There was no significant difference in sex,age,Cobb angle of scoliosis on coronal plane,and Cobb angle of kyphosis on saggital plane between 2 groups（P 0.05）.The operation time and blood loss were recorded;the Cobb angle of scoliosis on coronal plane and kyphosis on sagittal plane were measured at pre-and postoperation to caculate the rates of correction on both planes.Results The operation was successfully completed in all the patients.The operation time and blood loss of the patients in PSO group were significantly greater than those of the patients in non-osteotomy group（P 0.05）.All patients were followed up 12-56 months（mean,22.4 months）;no spinal cord injury occurred,and bone fusion was achieved at last follow-up.The Cobb angles of scoliosis and kyphosis at 2 weeks and last follow-up were significantly improved when compared with the preoperative angles in the patients of 2 groups（P 0.05）.There was no significant difference in Cobb angle of scoliosis and the rate of correction between 2 groups（P 0.05）,but the correction loss of PSO group was significantly smaller than that of non-osteotomy group（P 0.05） at last follow-up.At 2 weeks and last follow-up,the Cobb angle of kyphosis,the rate of correction,and correction loss were significantly better in PSO group than in non-osteotomy group（P 0.05）.Conclusion There is no signifcant difference in scoliosis correction between PSO and non-osteotomy techniques.PSO can get better corrective effect in kyphosis correction than non-osteotomy technique,but the operation time and blood loss would increase greatly.