多节段非对称Ponte截骨与全脊椎截骨术治疗重度僵硬性成人特发性脊柱侧后凸的影像学差异分析

Radiographic analysis of multilevel asymmetric Ponte osteotomy vs vertebral column resection in severe rigid adult idiopathic kyphoscoliosis

目的:对比多节段非对称Ponte截骨(multiple levels asymmetric Ponte osteotomy,MAPO)与全脊椎截骨术(vertebral column resection,VCR)在治疗重度僵硬性成人特发性脊柱侧后凸(adult idiopathic kyphoscoliosis,AIKS)的冠状面与矢状面影像学参数差异。方法:回顾性分析2009年5月~2016年3月间在我院接受后路MAPO或VCR手术,并随访2年以上的重度僵硬性AIKS患者。收集所有患者的术前、术后及末次随访的临床与影像学资料(脊柱全长正侧位X线片、脊柱全长左、屈位X线片)。根据术中截骨方式将所有患者分为MAPO组与VCR组。运用统计学分析比较两组患者术后及末次随访脊柱冠状面与矢状面的影像学参数(主弯Cobb角、局部后凸角、顶椎偏距、冠/矢状面平衡、胸椎后凸角与腰椎前凸角)差异,并对术前存在冠、矢状面失衡的患者进行亚组分析,评估冠、矢状面平衡的改善情况。结果:最终共对30例脊柱侧后凸患者的影像学资料进行分析研究。其中男性7例,女性23例,平均年龄26.97±8.88岁,平均随访时间28.70±7.05个月。MAPO和VCR两组主弯从分别从术前平均103.21°±16.97°及110.79°±15.97°矫正至48.58°±17.27°及57.33°±17.43°,主弯矫正率分别为(53.13±13.71)%与(48.89±12.81)%。局部后凸从术前平均85.21°±26.80°及93.3°±25.09°矫正至39.66°±20.28°及56.90°±21.36°,后凸矫正率分别为(47.20±19.92)%与(38.38±12.89)%。两组术后冠状面和矢状面影像参数包括冠、矢状面平衡、胸椎后凸角、腰椎前凸角等均有不同程度改善,但两组间差异无统计学意义。冠、矢状面亚组分析除VCR组矢状面平衡出现增加外,其余平衡参数均存在不同程度改善,但组内与组件并无统计学差异。VCR组的平均手术时间和出血量显著高于MAPO组。MAPO组并发症发生率明显低于VCR组。结论:多节段非对称Ponte截骨治疗重度僵硬性AIKS能够达到与VCR相似的冠状面与矢状面影像学改善,并显著减少手术时间和术后并发症的发生。

Objectives:To compare the coronal and sagittal radiographic difference of MAPO and VCR in severe rigid adult idiopathic kyphoscoliosis(AIKS).Methods:A retrospective study was conducted for patients with severe rigid AIkS who underwent posterior MAPO or VCR surgery in our hospital from May 2009 to March 2016.All the patients had at least 2 years follow-up.Clinical and radiographic data(full spine X-ray,full spine bending X-ray)before operation,immediately after operation,and at final follow-up were collected.All patients were divided into MAPO group and VCR group according to the osteotomy method.Statistical analysis was used to compare the differences in radiographic parameters including Cobb angle of main curve and focal kyphosis,apical vertebral translation,coronal and sagittal balance,thoracic kyphosis,and lumbar lordosis.Subgroup analysis was performed on patients with pre-existing coronal and sagittal imbalance to assess the improvement of coronal and sagittal balance.Results:A total of 30 cases with AlkS was analyzed.There were 7 males and 23 females with an average age of 26.97±8.88 years.The average follow-up time was 28.70±7.05 months.The main curves were corrected from the average of 103.21±16.970 and 110.79°士15.97 to 48.58±17.27 and 57.33±17.43 respectively.The main curve correction rate was(53.13±13.71)%and(48.89±12.81)%respectively.The local kyphosis was corrected from 85.210±26.80°and 93.3°±25.09°to 39.66°±20.28°and 56.90°±21.36,and the local kyphosis correction rate was(47.20±19.92)%and(38.38士12.89)%,respectively.Coronal and sagittal radiographic parameters including coronal and sagittal balance,tho-racic kyphosis,and lumbar lordosis all improved in two groups,and the difference between the two groups was not statistically significant.The subgroup analysisshowed that,except for the increase of sagittal balance in VCR group,the other parameters were improved to some extent,but there was no statistical difference be-fore and after surgery and the same between the two groups.The mean surgical time and blood loss in VCR group were significantly higher than those in MAPO group.The incidence of complication in MAPO groupwas significantly lower than that in VCR group.Conclusions:Multilevel asymmetric Ponte osteotomy for severe and rigid AIkS can achieve similar coronal and sagittal radiographic improvements with VCR and significantly reduce operative time and postoperative complications.