保留中柱经椎弓根开合式截骨术治疗老年僵硬性脊柱后凸畸形

Middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of stiff kyphosis

目的探讨保留中柱经椎弓根开合式截骨术治疗老年僵硬性脊柱后凸畸形的疗效和安全性。方法回顾性分析2016年1月至2018年4月收治的12例老年僵硬性脊柱后凸畸形患者的病历资料,均采用保留中柱经椎弓根开合式截骨术治疗。记录所有患者的手术时间、术中出血量、术后引流量、手术并发症、腰痛和下肢痛疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)和健康调查量表(the MOS item short from health survey,SF-36)。比较术前、术后及末次随访时矢冠状面矫正情况,矢状面参数包括腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、矢状面平衡(sagittal vertical axis,SVA),冠状面参数包括腰椎侧凸Cobb角、C7椎体中心至骶骨中垂线距离(C7 vertebral body center to humeral vertical line distance,C7PL-CSVL)。结果12例患者均顺利完成手术,手术时间为(238.20±65.95)min(范围,159~361 min),术中出血量为(440.50±133.60)ml(范围,120~600 ml)。术前ODI为65.92%±6.96%,末次随访时为21.00%±3.19%,差异有统计学意义(t=20.32,P<0.0001)。术前SF-36评分为(76.42±4.31)分,末次随访时为(103.10±4.57)分,差异有统计学意义(t=4.246,P=0.003)。术前腰痛VAS评分为(6.00±0.95)分,术后3个月为(2.33±0.89)分,末次随访为(1.42±0.51)分;术前下肢痛VAS评分为(6.91±1.24)分,术后3个月为(2.50±1.00)分,末次随访为(1.50±0.52)分;术后3个月、末次随访时腰痛及下肢痛VAS评分与术前比较,差异均有统计学意义(P<0.05)。术后及末次随访时矢状面参数LL(F=17.47,P<0.001)、SS(F=5.015,P=0.0125)、PT(F=14.66,P<0.001)及SVA(F=81.11,P<0.001)均较术前明显改善。术后及末次随访时冠状面参数腰椎侧凸Cobb角(F=87.19,P<0.001)和C7PL-CSVL(F=100.9,P<0.001)亦均较术前明显改善。结论保留中柱经椎弓根开合式截骨术治疗老年僵硬性脊柱后凸畸形具有操作简单、手术时间短、术中出血少等优点,能够有效地改善患者腰腿痛症状和生活质量,矫正后凸畸形,维持患者脊柱-骨盆平衡状态。

Objective To investigate the effectiveness and safety of middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of stiff kyphosis.Methods From January 2016 to April 2018,12 patients with stiff kyphosis in our department were treated with middle-column preserved pedicle subtraction closing-opening wedge osteotomy.The patients'operative time,intraoperative blood loss,postoperative drainage,surgical complications,low back pain and leg pain visual analogue scale(VAS),Oswestry dysfunction index(ODI)score,and SF-36 were recorded.These parameters were compared at preoperative,postoperative,and at the final follow-up.Coronal parameters included lumbar scoliosis Cobb angle,C7 vertebral body center to humeral vertical line distance(C7PL-CSVL),whilesagittal parameters includedlumbar Lordosis(LL),sacral slope(SS),pelvic tilt(PT),and sagittalvertical axis(SVA).Results All of 12 patients successfully completed the operation.The mean operation time was 238.20±65.95 min,the mean intraoperative blood loss was 440.50±133.60 ml.The patients’ODI score was 65.92%±6.96%at the preoperative,and 21.00%±3.19%at the final follow-up.The difference was statistically significant(t=20.32,P<0.0001).The VAS score of back pain was 6.00±0.95 at preoperative,2.33±0.89 at 3 months postoperatively,and 1.42±0.51 at the final follow-up.The VAS score of leg pain was 6.91±1.24 at preoperative,2.50±1.00 at 3 months postoperatively,and1.50±0.52 at the final follow-up.There was significant difference in SF-36 at preoperative and at final follow-up(P<0.05).The differences in LL,SS,PT and SVA at the preoperative and at final follow-up were statistically significant(F=17.47,P<0.001;F=5.015,P=0.0125;F=14.66,P<0.001;F=81.11,P<0.001).There was significant difference in lumbar scoliosis Cobb angle and C7PL-CSVL at the preoperative and at final follow-up(F=87.19,P<0.001;F=100.9,P<0.001).Conclusion The advantages of this surgical procedure includesimple operation,reducedsurgery time,and shorten intraoperative bleeding,which can effectively relief clinical symptoms,improve the quality of life,correctkyphosis,and maintain the patient's spinal-pelvic balance.