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分析

Orthopaedic effect and safety analysis of posterior vertebra column resection(VCR) for severe spinal deformity

目的探讨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。方法对我院2015年3月～2017年3月收治的重度脊柱畸形患者60例进行回顾性分析。所有入选患者均于手术前后行站立位全脊柱正侧位X片,术后对患者随访6～22个月。评估术前术后患者冠状面主弯Cobb角、矢状面后凸Cobb角、C7PLCSVL、SVA等影像学相关参数,采用Barthel指数与疼痛视觉模拟评分(VAS)评估临床效果,记录患者并发症发生情况。结果患者术后冠状面主弯Cobb角、矢状面后凸Cobb角较术前明显改善,差异具有统计学意义(P<0.05),术后C7PL-CSVL、SVA较术前明显改善,差异具有统计学意义(P<0.05);患者术后Barthel指数评分高于术前,VAS评分低于术前,较术前明显改善,两组比较,差异具有统计学意义(P<0.05);2例患者术后出现下肢感觉功能减退,1例患者出现胸腔积液。结论后路全椎体截骨矫形治疗重度脊柱畸形患者具有较好的矫形效果,但同时需要注意减少神经损伤等并发症的发生。

Objective To investigate the orthopedic effect and safety of posterior vertebra column resection(VCR) in the treatment of severe spinal deformity. Methods A total of 60 patients with severe spinal deformity admitted in our hospital from March 2015 to March 2017 were retrospectively analyzed. All the selected patients underwent standing position full spine positive lateral X piece, and the patients were followed up for 6-22 months after surgery. The coronal major curve Cobb angle, sagittal kyphosis Cobb angle, C7 PL-CSVL, SVA and other imaging parameters were evaluated before and after operation. Barthel index and pain visual analogue scale(VAS) were used to evaluate the clinical effect. And the complications of patients were recorded. Results The coronal major curve Cobb angle and sagittal kyphosis Cobb angle were significantly improved after surgery compared with those before surgery, and the difference was statistically significant(P<0.05). The postoperative C7 PL-CSVL and SVA were significantly improved compared with those before surgery. The difference was statistically significant(P<0.05). The postoperative Barthel index score was higher than that before surgery, and the postoperative VAS score was lower than that before surgery, which was significantly improved compared with preoperative. The difference between the two groups was statistically significant(P<0.05). Two patients had postoperative lower limb sensory dysfunction, and 1 patient developed pleural effusion. Conclusion Posterior total vertebral osteotomy for patients with severe spinal deformity has a good orthopedic effect, but at the same time the occurrence of complications such as nerve injury need to be paid attention to.