极重度脊柱侧后凸患者的后路一期小切口撑开联合二期全脊柱截骨术治疗

Surgical treatment of extremely severe scoliokyphosis by posterior approach: distraction at the first stage by small incisions combined with total spinal osteotomy at the second stage

目的：探讨后路一期小切口撑开联合二期全脊柱截骨术治疗极重度脊柱侧后凸的疗效和安全性。方法对26例行后路一期小切口撑开联合二期全脊柱截骨术的极重度脊柱侧后凸病例进行回顾性研究。其中男7例，女19例，年龄13～26岁，平均16.8岁。术前侧凸 Cobb’s 角98°～175°，平均135.33°；术前后凸 Cobb’s 角96°～170°，平均133.33°，后路矫形采用分期手术，一期采用小切口撑开矫形，使侧凸和后凸得到部分矫正。术后3～6个月再进行后路二期矫形，行后路截骨矫形内固定、剃刀背切除和植骨融合术，随访12～34个月，平均22个月。记录所有患者术前、一次术后、二次术前、二次术后和末次随访的影像学和临床资料以及围手术期并发症。结果所有病例均顺利完成手术，一期手术平均矫正侧凸61.43°（43.4%），二次手术矫正25.49°（34.45%）。间隔期矫形丢失率3.13%，总矫形率61.8%，随访末次矫形平均丢失率2.92%，最终总矫形率58.83%。术前后凸 Cobb’s 角95°～175°，平均133.33°，一期手术矫正后平均后凸 Cobb’s 角79.67°，二次手术矫正后平均后凸 Cobb’s 角45°，末次随访平均后凸 Cobb’s 角47.26°。躯干和双肩的失平衡均得到显著改善。无严重脊髓、呼吸系统等并发症出现。结论对于极重度脊柱侧后凸采用后路分两期手术治疗，降低了手术难度，提高了二次手术耐受力；可以获得良好的畸形矫形效果，手术安全性得到提高。

Objective To explore the effectiveness and safety of surgical treatment of extremely severe scoliokyphosis by two stages of posterior distraction and total spinal osteotomy technique.Methods Twenty-six patients with extremely severe scoliokyphosis （ 9 males, 17 females ） were retrospective analyzed. The mean age was 16.8 years （ range： 13-26 years ）. The mean preoperative Cobb’s angles were 135.33° （ range： 98°-175° ） for scoliosis and 133.33° （ 96°-170° ） for kyphosis. The surgical procedures were performed by two stages. The ifrst stage surgery was performed with posterior small incisions and distraction technique. Partial corrections of the scoliosis and kyphosis were achieve. The second stage surgery was performed 3-6 months after the ifrst stage surgery by posterior correction with total spinal osteotomy, shave abnormality excision and fusion. The mean follow-up period was 22 months （ range：12-34 months ）. Radiographs and clinical data were recorded preoperatively, after the ifrst surgery, before the second surgery, after the second surgery and in the latest follow-up. Perioperative complications were noted.Results All surgeries went smoothly. The average curve magnitude was reduced 61.43° （ 43.4% ） after the ifrst stage surgery and reduced 25.49 （ 34.45% ） after the second stage surgery. The lost of correction between two surgeries was 3.13%. The total major coronal curve correction was 61.8%. Loss of correction averaged 2.92% for major coronal curve and the ifnal correction rate was averaged 58.83%. The average major sagittal curve magnitude was 133.33° （ range： 95°-175° ）. The average total major sagittal curve was 79.69° after the ifrst stage surgery, 45° after the second stage surgery, and 47.26° in the latest follow up. Trunk and shoulder imbalance was signiifcantly improved. No severe complications in the spinal cord and respiratory system were noted.Conclusions Two-stage surgery is a safe and effective strategy for extremely severe kyphoscoliosis, which can improve the tolerance of patients to the second operation, reduce the risks＆amp;nbsp;and dififculties of the surgery and raise the correction rate and surgery safety.