Ponte截骨联合椎间隙颗粒骨打压植骨治疗胸腰椎半椎体后凸畸形

Ponte osteotomy combined with impacted morsellized bone graft interbody fusion for correction of hemivertebrae kyphosis in the thoracolumbar spine

[目的]探讨Ponte截骨联合椎间隙颗粒骨打压植骨矫正胸腰椎半椎体后凸畸形的有效性与安全性。[方法]2013年6月~2016年9月,手术治疗先天性胸腰椎半椎体后凸畸形15例,男9例,女6例;年龄14~35岁,平均(24.5±7.1)岁。T_(11)2例,T_(12)4例,L_13例,L_25例,L_31例。其中1例为初次手术失败,余为初次手术,均存在进行性加重的腰背部疼痛、后凸畸形,2例存在不同程度的神经功能障碍。采用Ponte截骨后刮除半椎体上下椎间盘得以松解椎间隙,完整保留前纵韧带及尽量保留骨性终板,在充分松解半椎体上下椎间隙的基础上行椎间隙内颗粒骨打压植骨实现初步矫形,再利用矫形棒进行二次矫形矫正后凸畸形。观察指标包括手术时间、出血量、后凸Cobb角变化、植骨融合情况、视觉模拟评分(visual analog scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、ASIA神经功能分级及并发症。[结果]15例患者均获得18~34个月的随访,平均(21.2±11.3)个月。随访18个月时均获得骨性融合。脊柱局部后凸角由术前的平均44.3°±13.5°(28°~57°)改善为术后平均7.5°±8.3°(-6°~12°),平均矫正率为82.3%。末次随访时VAS、ODI评分与术前比较均有明显改善,差异均有统计学意义(P<0.01)。ASIA神经功能分级:术后1例患者由C级转为D级、1例由D级转为E级。[结论]应用Ponte截骨联合椎间隙颗粒骨打压植骨治疗胸腰椎半椎体后凸畸形具有矫正角度满意、融合率高、手术创伤小、神经并发症少等优势,可获得满意的矫形效果与临床疗效。

[Objectives] To evaluate the outcomes and safety of Ponte osteotomy combined with interbody fusion with impacted morsellized bone graft for correction of hemivertebrae kyphosis in the thoraeolumbar spine. [Methods] from June：2013 to September 2016, 15 eases of hemivertebrae kyphosis in the thoraeolumbar spine were treated with surgery. Patients included 9 males and 6 females, aged 14-35 years old （mean, 24.5 ± 7.1 years）. The deformity was found in T11 in 2 eases, T12 in 4 eases, LI in 3 eases, L2 in 5 eases, and L3 in 1 eases. All eases suffered the pain of the lumbar and back, as well as the deformity of the back, meanwhile, 1 ease was initial operation failure, 2 eases had varying degrees of neurological dysfunction. In the operation procedure, the intervertebral space was loosened radically with Ponte osteotomy and diseeetomy, after the kyphosis was firstly corrected, the morcellized impacted graft technique was used. Afterwards, the kyphosis was secondly corrected using the correction rod technique with the hinge of the moreellized impacted graft. X-ray radiographic was then carried out for measurement of Cobb angle and bony Visual analogue scale （VAS）, Oswestry disability index （ODI） and ASIA were evaluated before and after surgery, and the operative duration time and blood loss were also recorded. [Results] all the 15 patients were followed up for 18-34 months, with an average of （21.2 ± 11.3） months. Bony fusion was achieved in all patients at 18 months fol- low-up. Localized kyphosis was reduced from an average of 44.3° （28°-57°） preoperatively to 7.5° （-6°- 12°） postoperatively, with an correction rate of 82.3% on average. At last follow-up, the ODI and VAS scores were significantly im- proved compared with the preoperative ones, and the differences were statistically significant （P〈0.01）. ASIA nerve function classification was improved from C to D in 1 case, and from D to E in another case. [Conclusion] Ponte osteotomy combined with interbody fusion with impacted morsellized bone graft can get large angle correction and high fusion rate in the treatment of hemivertebrae kyphosis in the thoracolumbar spine.