近端经皮椎弓根钉固定联合远端开放截骨矫形术治疗脊柱畸形

Therapeutic Effect of Proximal Transdermal Pedicle Screw Fixation Combined with Distal Open Osteotomy for the Treatment of Spinal Deformity

目的探讨近端经皮椎弓根钉固定联合远端开放截骨矫形术治疗脊柱畸形的临床疗效.方法选择2015年1月至2017年1月云南省第二人民医院收治的脊柱畸形患者80例为研究对象,按随机数字表法分为观察组和对照组,每组40例,观察组采用近端经皮椎弓根钉固定联合远端开放截骨矫形术治疗,对照组采用单纯椎管减压合并融合内固定术治疗.对两组患者的手术进行过程、手术并发症、术后疗效、随访情况、功能障碍指数(ODI)等进行比较观察.结果(1)观察组患者的手术时间长于对照组(P<0.05),其他指标组间比较无统计学意义(P>0.05);(2)术后3个月影像学复查时观察组患者的矢状面躯干偏移(SVA)、冠状面Cobb角、腰椎前凸角(LL)、骨盆倾斜角(PT)均低于对照组,而畸形矫正率高于对照组(P<0.05);(3)术后3个月观察组ODI各项评分包括疼痛程度、日常活动、睡眠质量、社交活动能力评分均低于对照组(P<0.05);(4)观察组术中并发症发生率为7.50%(3/40),对照组并发症发生率为12.50%(5/40),组间无统计学差异(P>0.05).结论与单纯椎管减压术相比,近端经皮椎弓根钉固定联合远端开放截骨矫形术治疗脊柱畸形的临床疗效显著,能够显著提高脊柱畸形矫正率,提高患者术后生活质量,手术安全性好,值得进一步临床推荐使用.

Objective To study the clinical effect of proximal percutaneous pedicle screw fixation combined with distal open osteotomy for the treatment of spinal deformities. Methods From January 2015 to January2017, 80 cases of spinal deformity in our hospital were selected and divided into observation group and control group according to random number table, 40 cases in each group. The observation group was treated with proximal percutaneous pedicle screw fixation combined with distal open osteotomy, while the control group was treated with simple spinal canal decompression combined with internal fixation. The procedures,complications, postoperative curative effect, follow-up, and dysfunction index（ODI） were observed in the two groups. Results（1） The operative time of the observation group was longer than that of the control group（P 〈0.05）, and there was no significant difference for other indicators between the two groups（P 〉 0.05）.（2） The sagittal plane trunk migration（SVA）, coronal Cobb angle, lumbar anterior convex angle（LL） and pelvic inclination（PT） in the observation group were lower than those of the control group 3 months after the reexamination, and the rate of malformation correction was higher than that of the control group（P 〈 0.05）. 3 months after the operation, the scores of ODI, including pain, daily activities, sleep quality and social activities ability of the observation group were all lower than those of the control group（P 〈 0.05）.（4） The incidence of intraoperative complications in the observation group was 7.50%（3/40）, while the incidence of complications in the control group was 12.50%（5/40）, and there was no significant difference between the two groups（P 〉 0.05）. Conclusion Compared with simple decompression of spinal canal, proximal percutaneous transpedicular screw fixation combined with distal open osteotomy is effective in the treatment of spinal deformities. It can significantly improve the correction rate of spinal deformity, improve the quality of postoperative life of the patients, and the operation is safe and worthy of further clinical recommendation.