脊髓内移术在脊柱角状侧后凸畸形伴神经损害的后路矫形内固定中的作用

Role of transvertebral transposition of the spinal cord in the treatment of neurologic deficit secondary to angular kyphoscoliosis

目的探讨脊髓内移术在脊柱角状侧后凸畸形伴神经损害的后路矫形内固定中的作用。方法回顾性分析2005年1月至2013年6月接受脊髓内移术＋脊柱后路矫形内固定术治疗的伴神经损害的脊柱角状侧后凸畸形且随访1年以上的12例患者，男7例，女5例；年龄6-53岁，平均（21＋14）岁。先天性脊柱侧后凸畸形伴神经损害9例，特发性脊柱侧后凸畸形伴神经损害3例。脊髓功能Frankel分级C级3例，D级9例。冠状面主弯Cobb角79．4°±16．2°，脊柱后凸角68．3°±25．0°。在MRI上测量脊髓内移术前后顶椎区凸侧脊髓外缘距椎管内缘的距离，在X线片上测量矫形术前后及末次随访时冠状面主弯Cobb角和矢状面后凸Cobb角。结果随访1-5年，平均2年。术后即刻脊髓功能Frankel分级C级1例、D级4例、E级7例，与术前相比改善1级7例，改善2级1例，4例未见明显改善；末次随访时脊髓功能均得到明显改善，D级1例、E级11例，与术前相比改善1级10例、改善2级2例。脊髓内移术后，顶椎区凸侧脊髓外缘至椎管内缘的距离由平均（11．9±6.4）mm减小至（9．8±6．9）mm。后路矫形术后侧凸Cobb角为39．3°±15．1°，矫正率为50．3％±20．5％；后凸Cobb角为41．30±16．60，矫正率为39．0％±13．0％。末次随访时侧凸矫正丢失率为6．1％±7．5％，后凸矫正丢失率为3．1％±4．2％。结论脊髓内移术＋脊柱后路矫形内固定术可显著改善脊柱角状侧后凸畸形患者的神经功能，且不影响侧后凸畸形矫形疗效。

Objective To explore the role of transvertebral transposition of the spinal cord in the treatment of the patients suffering from angular kyphoscoliosis with neurologic deficit. Methods Twelve patients with at least 1 year follow-up, including 5 females and 7 males, suffering from neurologic deficit secondary to angular kyphoscoliosis underwent transvertebral transposition of the spinal cord and posterior correction from January 2005 to June 2013 were retrospectively analyzed. The initial age averaged 21±14 years. The etiologies of deformity were congenital kyphoscoliosis in 9 patients, idiopathic kyphoscoliosis in 3 patients. Preoperative spinal cord function graded by Frankel criteria was 3 cases of grade C and 9 of grade D. The initial major curve was 79.4°±16.2° with a global kyphosis of 68.3°±25.0°. The change of distance between spinal cord and canal on the convex side at the apex was measured on MR images to evaluate the efficacy of transposition; in addition, Cobb angle on coronal and sagittal plane was evaluated before surgery, on discharge and at the last follow-up. Results All patients were followed up for 2 years on average （1-5 years）. The post operation spinal function evaluated by Frankel criteria were as follow： with grade C of 1 case, grade D of 4 cases and grade E of 7 （7 cases changed one grade, 1 case changed two grades, 4 cases did not change obvious）. At the last follow-up, all the cases got obvious recovery of spinal function, with 1 case of grade C and 11 of grade D （10 cases changed one grade, 2 cases changed two grades）. The distance between spinal cord and canal on the convex side at the apex changed from 11.9±6.4 mm to 9.8±6.9 mm. After surgery, the major curve improved to 39.3°±15.1° with 50.3%±20.5% correction rate, and the mean loss of correction was 6.1%±7.5%. The mean kyphosis was 41.3°v16.6°, demonstrating a 39.0%±13.0% correction rate immediately after operation, and showing 3.1%±4.2% correction loss at the final follow-up. No neurologic complications or no death occurred intra- and post-operatively. No screw or rod fracture, instrumentation loosening and pseudarthrosis were found during follow-up. Conclusion Transvertebral transposition of the spinal cord and posterior correction is a useful procedure for the recovery of neurologic deficit secondary to angular kyphoscoliosis, with good results of deformity correction.