后路脊柱去松质骨截骨治疗Pott′s角状后凸畸形的安全性及有效性

The safety and reliability of posterior vertebral column decancellation for the management of Pott′s sharp kyphosis deformity

目的：探讨不使用传统钛网支撑植骨的后路脊柱去松质骨截骨术（posterior vertebral column decancellation,PVCD）治疗Pott′s角状后凸畸形的安全性及有效性。方法 ：回顾性分析2010年8月~2014年5月于我院行PVCD治疗且资料完整的26例Pott′s角状后凸畸形患者的临床资料,其中男11例,女15例,年龄24.8±7.6岁（14~46岁）。后凸顶点位于胸椎6例,胸腰段18例,腰椎2例。术前ASIA分级C级1例,D级4例,E级21例。记录并分析手术前后及末次随访时的后凸Cobb角、顶椎区域前柱和后柱长度变化、手术时间、术中出血量、手术并发症。结果：手术时间为306.2±59.5min（200~420min）,术中出血量为2046.2±742.4ml（1000~4000ml）。5例患者围手术期出现并发症,其中一过性神经症状2例,脑脊液漏3例。术前后凸Cobb角为91.3°±17.5°（66°~140°）,术后为17.1°±6.2°（4°~30°）,矫正74.2°±18.1°,矫正率为（80.9±6.6）%。截骨部位前柱增加3.6±3.1cm（0~8.4cm）,后柱短缩2.7±1.1cm（1.3~4.8cm）。所有患者均获随访,随访时间为30.8±16.5个月（12~60个月）。末次随访时后凸Cobb角为20.3°±6.1°（9°~33°）,矫正平均丢失3%。末次随访ASIA分级C级患者恢复为D级,3例D级患者恢复为E级,1例D级患者无恢复。结论：不使用传统钛网支撑植骨的PVCD技术是治疗Pott′s后凸畸形的一种安全有效的方法。

Objectives： To explore the safety and effectiveness of bony cage rather than titanium mesh in posterior vertebral column decancellation（PVCD） in the management of Pott＇s sharp kyphosis deformity. Methods： Prospective analysis of 26 patients with Pott＇s deformity underwent PVCD from August 2010 to May 2014, with a minimuM follow-up of 1 year and a maximuM follow-up of 5 years. There were 11 males and 15 females with an average age of 24.8±7.6 years old. Among them, the number of apical vertebrae located in thoracic region, thoracolumbar region and lumbar region was 6, 18 and 2, respectively. 1 patient was in grade C, 4 patients were in grade D and 21 patients were in grade E according to ASIA scale. The perioperative data were recorded, which included preoperative Cobb angle, postoperative Cobb angle, final follow-up Cobb angle, apical vertebrae, the length difference of anterior column and posterior column, operation time, perioperative blood loss and complications. Results： The average operation time was 306.2±59.Smins. The average blood loss was 2046.2±742.4ml. Complications were noted in 5 patients. 2 cases were complicated with transient neurological deficits and 3 cases with cerebrospinal fluid（CSF） leak. The kyphosis Cobb angle decreased from 91.3°±17.5° to 17.1°±6.2°, with a correction rate of （80.9±6.6）%. The average time of followup was 30.8±16.5 months. The Cobb angle was 20.3°±6.1° and the loss of con＇ection was 3% in the final follow-up. The anterior column increased by 3.6±3.1cm while posterior column shortened by 2.7±1.1cm. Among 5 patients with preoperative neurological deficit, one patient with ASIA C improved to ASIA D, 3 patients improved from ASIA D to ASIA E, one patient with ASIA D did not recover in the last follow-up. Conclusions： PVCD without using conventional titanium mesh is a safe and effective option for Pott＇s deformity.