后路经顶椎椎弓根截骨治疗重度僵硬性特发性脊柱侧凸

Efficacy and safety of vertebrae pedicle subtraction osteotomy by posterior trans apical for correction of severe and rigid idiopathic scoIiosis

目的评价后路经顶椎楔形椎弓根截骨（PSO）治疗重度僵硬性特发性脊柱侧凸的适应证、手术疗效及安全性。方法回顾性分析2003年1月至2014年12月在新疆医科大学第一附属医院脊柱外科行后路经顶椎楔形截骨矫形固定融合术治疗的重度僵硬性特发性脊柱侧凸18例。术前、术后及随访时拍摄站立位全脊柱X线片，测量冠状面、矢状面侧凸Cobb角、躯干矢状面偏移距离、顶椎偏移距离及身高变化，记录脊柱融合固定节段和融合情况。结果所有患者均获得随访。融合固定节段为11-17（13．7±1．8）节。冠状面主弯Cobb角由术前（94．3±13．3）°矫正至（32．4±14．8）°，矫正率为64．8％。矢状面后凸Cobb角由术前（62．5±17．8）°，矫正至（27．I±11．7）°，矫正率为82．6％。末次随访时冠状面和矢状面Cobb角无明显矫正丢失。躯干矢状偏移距离由术前平均-29．8mm矫正至-3．5mm，平均矫正26．2mm。顶椎冠状偏移距离由术前平均7．9em，矫正至2．5cm。术后身高平均增加7．6（3．5-11）cm。围手术期并发症主要包括胸膜破裂4例，脑脊液漏2例，一过性神经损害2例，迟发性感染1例。结论对重度僵硬性特发性脊柱侧凸采取后路经顶椎PSO截骨矫形及内固定是较为安全、有效的方法。

Objective To evaluate the efficacy and safety of pedicle subtraction osteotomy for correction of severe rigid idiopathic scoliosis. Methods From January 2003 to December 2014, eighteen patients with severe rigid idiopathic scoliosis were treated by posterior wedge osteotomy in department of spinal surgery, the First Affiliated Hospital of Xinjiang Medical University. There were 5 males and 13 females, and the average age at was （ 16. 9 ± 9. 1 ） years, and the average follow-up was 47. 6 months. The coronal and sagittal Cobb＇s angles, sagittal trunk shifts, apical vertebral translation, height change and fusion segments were measured on standing AP and lateral radiographs before, after surgery and the final follow-up. Results The Cobb＇s angle in the coronal plane was corrected from （94. 3 ± 13.3 ） ° to （31.6 ± 14. 8）°, representing 64. 8% correction rate. The Cobb＇s angle in the sagittal plane was corrected from （62. 5 ± 17. 8）°to （27.1 ± 11.7）°, representing 82. 6% correction rate. Coronal trunk shift was obviously improved from -29. 8 mm to -3.5 mm. the average fusion segments was 13.7 ± 1.8 ranging from 11 to 17 segments. Perioperative complications consisted of pleura injury in 4 cases, cerebrospinal fluid leakage in 2 cases transient neurological damage in 2 cases and delayed infection in 1 case. Conclusion Pedicle Subtraction Osteotomy correction by the single posterior approach is a reliable and safe surgical technique for correction of severe rigid idiopathic scoliosis.