僵硬性成人退变性脊柱侧凸的截骨方式的选择

Osteotomy methods for adult fixed degenerative spine scoliosis

目的 探讨僵硬性成人退变性脊柱侧凸的的影像学特征及截骨方式选择。方法 收集自2011-01—2014-09诊治的45例僵硬性成人退变性脊柱侧凸行长节段固定截骨矫形的完整病例资料,按照截骨方式分为2组。SPO组28例,PSO组17例,根据术前全脊柱X线片、Bending像及CT三维重建判断脊柱僵硬性及僵硬来源,选择截骨方式,SPO或PSO,分析2组术前及末次随访的脊柱影像学指标及疗效结果 。结果 45例获得随访6~45个月,平均22.4个月。2组术前及末次随访的ODI及VAS评分比较,差异有统计学意义（P〈0.05）,SPO组Cobb角改善率为69.33%,PSO组Cobb角改善率为76.14%,2组重新获得了脊柱冠矢状面平衡,2种截骨方式均取得良好的疗效。SPO组,手术时间155~290 min,平均213 min,出血量700~1 550 ml,平均1 253 ml,脑脊液漏5例,感染1例,内固定松动1例;PSO组,手术时间160~320min,平均264 min,出血量900~2 200 ml,平均1 756 ml,脑脊液漏4例,感染1例,无内固定松动。结论 成人僵硬性脊柱退变性侧凸的截骨方式应根据术前影像学资料进行选择,主要因素有局部角状侧后凸畸形、腰椎后凸、椎间隙骨化、关节突融合及矢状面失衡情况;尽量使用SPO解决脊柱退变性侧凸的矫形问题,但严重脊柱畸形需要使用PSO进行矫形;2种截骨方式都取得良好的临床和影像学疗效。

Objective To investigate the radiographic features and surgical osteotomy methods for adult fixed degenerative spine scoliosis. Methods Forty five cases of adult fixed degenerative spine scoliosis receiving long segmental fixed osteotomy in our hospital from January 2011 to September 2014 were reviewed retrospectively, including 28 cases of SPO and 17 cases of PSO. The osteotomy approaches were selected by means of CT scans which assessed the sites of the spine deformity. The result of radiography and efficacy of two groups before operation and at the last-follow were analyzed. Results Surgical treatment of 45 patients were successfully completed with no death. All patients were followed up for an average period of 22.4 months postoperatively. ODI and VAS of all last-follow were superior to those before operation, which were also statistically significant （P 〈0.05）. The improvement rate of Cobb angle was 69.33% in SPO group, and 76.14% in PSO group. The two groups restored the coronal and sagittal balance of spine, and the two osteotomy approaches obtained good clinical efficacies. The average time of operation was 213 minutes, and the average blood loss was 1 253 rnl in SPO group, which included 5 cases of cerebrospinal leak, 1 case of infection and 1 case of internal fixation loosening. The average time of operation was 264 minutes, and the average blood loss was 1 756 ml in PSO group, which included 4 cases of cerebrospinal leak, 1 case of infection and nothing of internal fixation loosening. Conclusion The choice of surgical osteotomy approaches for adult fixod degenerative spine seoliosis depends on the preoperative imaging information, including local angular deformity, lumbar kyphosis, intervertebral disc ossification, facet fusion and sagittal imbalance. SPO may settle the orthopedic problem of degenerative spine scoliosis, but severe degenerative spine scoliosis needs PSO. The two osteotomy approaches obtained good clinical efficacies.