三维重建技术辅助后路手术治疗陈旧结核性脊柱后凸畸形

Three dimensional reconstruction technology assist posterior surgery to treat obsolete tuberculous kyphosis

目的探讨三维重建技术在后路手术治疗陈旧性脊柱后凸畸形中的意义。方法该院自2006年4月-2012年4月共收治20例陈旧结核性脊柱后凸畸形患者,其中,男8例,女12例,年龄26-58岁,平均41.2岁。术前常规行X线、CT、MRI检查,应用三维重建技术制作立体图像,指导手术设计并模拟手术。根据手术前后后凸角度变化及后凸矫正率来评定矫形效果;应用视觉模拟评分（VAS）分别评价疼痛缓解情况;应用Frankel分级来评价下肢神经功能障碍情况。结果该组病例均顺利完成手术,矫形及内固定满意,仅1例出现一过性神经损伤。术后随访时间为12-38个月,平均28.2个月。患者后凸角从平均60.6°减小至平均15.9°,后凸矫正率为73.8%;VAS评分从平均6.1降低至1.9;Frankel分级E级从5例增加至10例。术前与术后1周、末次随访比较,后凸角度差异有统计学意义（t分别为17.7和17.1,P〈0.05）;VAS评分差异有统计学意义（t分别为41.8和31.1,P〈0.05）。结论应用三维重建技术辅助治疗陈旧结核性脊柱后凸,可指导手术设计,制定个体化手术方案,取得满意的疗效。

[Objective] To investigate the significance of the three-dimensional reconstruction technology in the posterior surgical treatment of obsolete tuberculous kyphosis. [Methods] 20 obsolete tuberculous kyphosis patients including 8 males and 12 females with the average age of 41.2 years old （from 26 to 58 years old）, who were treated from April 2006 to April 2012 in our hospital. This group of cases were routine preoperative X-ray, CT, MRI imaging, then make 3D image by the three-dimensional reconstruction technolo- gy, which can guide operation design and simulate operation. The kyphosis angle for orthopedic effect, the vi- sual analogue scale （VAS） for pain level, were applied before and after surgery, as well as follow-up. The Frankel grading system for neurological function of lower extremities was applied before surgery and at follow- up. [Results ] This group of patients were successfully operated. The orthopedic and the position of the pedi- cle screw were satisfying, and only one case experienced temporary nerve damage. The average follow-up time was 28.2 months （from 12 months to 38 months）. The average kyphosis angle decreased from an average of 60.6° to an average of 15.9°, with an average corrective rate of 73.8% at the final follow-up; the VAS score decreased from an average of 6.1 to an average of 1.9; the Frankel grade E-Class increased from 5 cases to 10 cases. The postoperative kyphosis angle and the VAS score 1 week and the final follow-up after operation were significantly different with that of pre-operation （for kyphosis angle： t= 17.7 and 17.1, P〈0.05; for VASscore： t = 41.8 and 31.1, P〈0.05）. [Conclusion] Satisfactory results can be achieved by applying the three- dimensional reconstruction technology, which can guide the surgical design and develop individualized surgical plan, to adjuvant therapy obsolete tuberculous kyphosis.