后路全椎体截骨治疗重度脊柱畸形的疗效分析

Clinical effect of posterior vertebral column resection for severe spinal deformity

[目的]评估后路全椎体截骨矫形（VCR）治疗重度脊柱畸形的矫形效果及安全性。[方法]回顾性分析本院脊柱外科2007年2月-2012年2月收治的重度脊柱畸形患者36例,男24例,女12例,其中侧凸1例,后凸7例,侧后凸28例,平均年龄20.9（10-66）岁,平均随访66.7（42-107）个月。所有患者具有完整的病历记录和术前术后随访全脊柱正侧位X线片。评估的临床参数包括：年龄、病因、术中出血量、手术时间和并发症发生率;影像参数包括：术前术后侧凸和后凸Cobb角、侧凸和后凸矫正率、主弯柔韧度、C_7-CSVL、C_7-SSVL、双肩高度差、截骨节段数、置钉数及是否放支撑物。[结果]所有患者共截骨37例次,其中胸椎截骨30例次,腰椎截骨7例次,平均截骨1.3（1-3）个节段,置入钛网10枚,Cage 6枚,平均融合13.1（5-17）个节段,平均置钉16.6枚,主弯从术前平均Cobb角120.5°矫正至术后平均58.8°（52.2%）,末次随访平均61.5°（48.1%）,术前主弯柔韧度平均为15.4%,术前后凸平均112.6°,术后矫正至平均48.7°（57.1%）,末次随访平均为51.2°（53%）,冠状面、矢状面和双肩高度差都获得良好的平衡,术中平均出血量2 909（800-8 200）ml,平均手术时间534.4（364-885）min。36例患者出现16例次并发症,其中6例发生神经并发症,发生率为16.7%。[结论]后路全椎体截骨矫正重度脊柱畸形是一种行之有效的方法,术中多模式诱发电位监测可提高脊髓神经安全性,多科室合作可减少术中及术后并发症。

[Objective] To analyze the corrective outcome and complications of posterior vertebral column resection（ PVCR） for severe spinal deformity. [Methods] A total of 36 patients（ male 24 and female 12） with severe spinal deformity subjected to PVCR were admitted to our hospital from Feb 2007 to Feb 2012,with mean age of 20. 9 years old（ range,10 - 66years）. All patients had complete clinical records,standing anteroposterior and lateral radiographs before,two week after surgery and at the final follow- up. The age,pathogenesis,intra- operative blood loss,operation time and rate of complications were recorded and twelve radiographic parameters,as standard for effectiveness evaluation,were also assessed before and after surgery,including Cobb angle,deformity correction rate,main curve flexibility,C_7- CSVL,C_7- SSVL,height difference between shoulders,number of resected segments,number of implanted screws and usage of support implantation. [Results]All cases were followed up for an average of 66. 7 months（ range,42 - 107 months）. The number of resected vertebrae averaged 1. 3 levels（ 1 - 3）,with the total number of 37（ 30 thoracic and 7 lumbar）. Average fusion segment was 13. 1（ 5 - 17）and average implanted screws was 16. 6. The supporting implantation included 10 titaniums mesh and 6 Cages. The mean coronal main curve was corrected from preoperative 120. 5° to 58. 8°（ 52. 2%） immediately after operation,and 61. 5°（ 48. 1%） at the final follow- up. The mean preoperative kyphosis of 112. 6° was corrected to 48. 7°（ 57. 1% correction） immediately after operation,and 51. 2°（ 53%） at the final follow- up. The balance of coronal,saggital and shoulder discrepancy had been successfully acquired immediately after operation and at last follow- up. Mean operative blood loss was 2 909（ 800 - 8 200） ml,mean operation time was 534. 4（ 364 - 885） mins, 16 complications were found in 36 patients,including 6 neurogenic complications（ 16. 7%）. [Conclusion] PVCR is an efficient alternative for severe rigid scoliosis. Multi- modal neurogenic mo-nitoring can improve neural safety and more importantly,team work can effectively decrease peri- operative complications.