改良PVCR治疗胸腰段先天性楔形椎引起脊柱后凸畸形的疗效分析

Modified posterior vertebral column resection for the treatment of thoracolumbar kyphosis caused by wedged vertebrae

目的：探讨后路单侧截骨部分椎体切除矫形术（ PUVCR）治疗胸腰段先天性楔形椎引起脊柱后凸畸形的临床疗效。方法采用前瞻性随机对照研究，选择河北医科大学第三医院脊柱外科2010年1月-2013年5月29例胸腰段先天性楔形椎引起脊柱后凸畸形患者纳入研究。随机分为两组：观察组14例，接受PUVCR；对照组15例，接受后路全椎体切除术（ PVCR）。观察组男6例，女8例，年龄（26.7±4.7）岁（17~33岁），术前后凸Cobb角平均为62.3°±7.6°；对照组男7例，女8例，平均年龄为（24.3±3.8）岁（18~32岁），术前后凸Cobb角平均为58.3°±8.7°。评估并比较两组患者手术时间、术中出血量及术后引流量、后凸矫正度（ Cobb角法）、神经功能改善情况（ Oswestry功能障碍指数）及疼痛缓解程度（视觉模拟评分）。结果两组患者的年龄、性别组成、术前后凸Cobb角比较差异无统计学意义（P值均〉0.05）。观察组的手术时间、术中出血量、术后引流量均少于对照组（P值均〈0.05）。两组间比较，术后2周后凸Cobb角的矫正度、术后1年矫形丢失程度、术后1年神经功能恢复指标Oswestrg功能障碍指数、疼痛视觉模拟评分的改善程度差异均无统计学意义（ P值均〉0.05）。对照组术中神经根损伤发生2例，观察组术中发生1例。两组病例术后1年椎间植骨均骨性融合。结论对于胸腰段先天性楔形椎引起的脊柱后凸畸形，改良PVCR可获得与PVCR同等的后凸矫正、神经功能恢复及疼痛改善，但手术时间更短、出血更少、神经根损伤发生率更低，疗效确切。

Objective To explore the effect of modified posterior unilateral vertebral column resection（ PUVCR ） through unilateral approach for the treatment of thoracolumbar kyphosis caused by wedged vertebrae. Methods From Jan. 2010 to May 2013, 29 cases of spinal kyphosis caused by wedged vertebrae were treated in the third hospital of Hebei Medical University and enrolled in this study, 14 patients received PUVCR as experimental group with six males and eight females, the average age was （26. 7 ± 4. 7）years （17 -33 years）, the preoperative kyphotic angle was 62. 3° ± 7. 6°. Fifteen patients received posterior vertebral column resection （ PVCR） as control group with seven males and eight females, the average age was （24. 3 ± 3. 8） years （18 - 32 years）, the preoperative kyphotic angle was 58. 3° ± 8. 7°. The clinical records were reviewed and compared for operating time, operative and postoperative blood loss, correction of kyphotic deformity, functional improvement （ Oswestry disability index, ODI ） , pain （ visual analog scale, VAS ） and complications. Results The two groups were compatible in age, sex composition and preoperative kyphotic（all P values〉0. 05）. There was no difference between PVCR and PUVCR groups in terms of correction of kyphotic angle two weeks postoperatively, loss of correction in one-year follow up, improvement of ODI and decrease of VAS in one-year follow up （ all P values〉0. 05）. The operating time in PUVCR group was shorter than that in PVCR group. The blood loss and postoperative loss in PUVCR group was less than that in PVCR group（all P values〈0. 05）. The rate of intraoperative unintentional impingement was 13. 3%（2/15） in PVCR group and 7. 1%（1/14） in PUVCR group. All patients achieved bony fusion in one-year follow up. Conclusions Satisfactory correction of sagittal deformity, functional improvement and pain relief can be achieved with PUVCR, Which can shorten the operating time, lessen blood loss and lower rates of nerve root impingement compared to PVCR.