分期与一期矫正重度脊柱侧弯近期结果比较

Comparison of short-term outcomes of staged versus one-stage surgical correction for severe scoliosis

[目的]比较分期与一期手术矫正青少年重度脊柱畸形的近期疗效。[方法]回顾性分析本院2012年6月～2017年6月手术矫正的重度脊柱畸形患者76例。其中,分期组52例,一期手术安装颅盆环,牵伸矫正畸形,二期后路松解,继续颅盆环牵伸矫正,三期去除颅盆环,行内固定矫正;一期组24例,一期行后路矫正内固定术。比较两组手术并发症、身高变化和影像测量脊柱侧弯Cobb角。[结果]分期组围手术期神经并发症发生率7.69%(4/52),一期组为25.00%(6/24),差异具有统计学意义(P<0.05)。经逻辑回归分析发现,术前Cobb角、合并脊髓畸形以及手术方法与神经并发症发生显著相关(P<0.05)。两组患者术后身高均较术前显著增加(P<0.05)。术前两组患者身高的差异无统计学意义(P>0.05),但术后1周、术后3个月和术后6个月,分期组患者身高均显著大于一期组(P<0.05)。两组患者术后Cobb角均较术前显著减小(P<0.05)。术前两组Cobb角间差异无统计学意义(P>0.05);但术后1周、术后3个月和术后6个月,分期组患者Cobb角均显著小于一期组(P<0.05)。[结论]颅盆牵引加软组织松解联合后路内固定术治疗重度脊柱畸形是一种安全有效的方法,能显著改善侧弯矫正效果,并降低神经并发症风险。

[Objective] To compare the short-term clinical outcomes of staged versus one-stage surgical correction for severe scoliosis in adolescent and young adult.[Methods] A retrospective study was conducted on 76 patients who underwent surgical correction for severe scoliosis in our department from June 2012 to June 2017. Of them, 52 patients in the staged group had scoliosis corrected by halo-pelvic distraction after installing the frame in the first stage operation, soft tissue release combined with thoracoplasty in the second stage surgery followed by continuous halo-pelvic distraction, and then remove of the external frame combined with posterior instrumentation correction and internal fixation in the third stage procedure;while 24 patients in the one-stage group received posterior instrumentation correction and internal fixation in one stage. The complications,body height and Cobb angle measured on radiographs were compared between two groups.[Results] The perioperative neurological complication proved 7.69%(4/52) in the staged group, whereas 25.00%(6/24) in the one-stage group, which was statistically significant(P<0.05). The logistic regression revealed that the Cobb angle preoperatively, spinal cord deformity accompanied and surgical strategy used were statistically significantly related to the perioperative neurological complications(P?0.05). The body height significantly increased after operation in both groups compared with that before operation(P?0.05). Although no significant difference was noted in Cobb angle between the two groups before operation(P>0.05), the staged groups had statistically significantly less Cobb angle than the one-stage group at 1 week, 3 months and 6 months postoperatively(P<0.05).[Conclusion] Halo pelvic distraction and soft tissue release combined with posterior instrumentation is a safe and effective method for treatment of severe spinal scoliosis, which not only considerably improve the outcomes of deformity correction, but also reduce the risk of perioperative neurological complications.