青少年重度颈椎后凸畸形手术矫正

Surgical correction for severe cervical kyphosis in adolescent

[目的]探讨青少年重度颈椎后凸畸形的手术方式、临床疗效及矢状面平衡。[方法]对2012年7月~2017年6月手术矫正的重度青少年颈椎后凸畸形患者18例进行回顾性分析。其中,采用前路手术13例,前后联合手术5例。采用VAS、NDI和JOA评分,以及颈椎后凸Cobb角(RKA)、C_(2)~C_(7)角、C_(0)~C_(2)角、C7倾斜角、C_(2)~C_(7)矢状位轴向垂直距离和颈椎后凸指数评价临床效果。[结果]18例患者均顺利完成手术,未见严重血管及神经损伤等并发症。随访24~36个月,平均(27.33±5.53)个月。所有患者术后颈部外观畸形均有明显改善,颈部疼痛症状消失。术后1个月及末次随访VAS、NDI及JOA评分均较术前有显著改善(P<0.05)。影像方面,术后颈椎后凸Cobb角平均矫正41.84°,矫正率80.98%,末次随访矫正丢失率7.31%。术后及末次随访C_(2)~C_(7)角和C_(0)~C_(2)角以及颈椎后凸指数较术前显著改善(P<0.05);而C7倾斜角和C_(2)~C_(7)矢状位轴向垂直距离较术前有所改善,但差异无统计学意义(P>0.05)。术后12个月X线片显示患者均达到椎间植骨骨性愈合,无内固定松动。[结论]采用前路手术或前后联合手术矫治青少年重度颈椎后凸畸形临床疗效满意,能够显著改善颈椎后凸畸形及矢状面平衡。

[Objective]To explore the surgical techniques and their clinical outcomes and varies in sagittal alignment on images for severe cervical kyphosis in the adolescent.[Methods]Between July 2012 and June 2017,a total of 18 patients who underwent cervical decompression and instrumented fusion for severe adolescent cervical kyphosis were studied retrospectively.Of them,13 patients received the anterior surgical interferences only,while the remaining 5 patients had the combined anterior and posterior surgical procedures performed.The clinical outcomes were evaluated by using the visual analogue scale(VAS)of neck pain,neck disability index(NDI)and Japanese Orthopaedic Association(JOA)score,as well as the regional kyphosis angle,C_(2)~C_(7)angle,C_(0)~C_(2)angle,C7 slope,C_(2)~C_(7)sagittal vertical axis(SVA)and kyphotic index(KI)measured on radiographs.[Results]All the patients had operation finished successfully without serious complication,such as injury to blood vessels and nerves.The follow-up period lasted for 24 to 36 months with a mean of(27.33±5.53)months.All the patients got significant improvement in cervical deformity and pain relief after operation.The VAS,NDI and JOA score significantly improved at 1 month after operation and the latest follow up compared with those before operation(P<0.05).With regard to radiographic assessment,the correction of the cervical kyphosis was of 41.84°,with correction rate of 80.98%after operation,and correction loss rate of7.31%at the latest follow up.In addition,the C_(2)~C_(7)angle,C_(0)~C_(2)angle and KI significantly improved at 1 month after operation and the final interview compared with those before operation(P<0.05),although the C7 slope and C_(2)~C_(7)SVA slightly improved without statistical significance(P>0.05).To 12 months after operation,bony fusion was achieved in all the 18 patients without loosening of the implants.[Conclusion]The anterior cervical decompression and instrumented fusion,or combined anterior and posterior cervical decompression and instrumented fusions are effective and safe for correcting severe cervical kyphosis in the adolescent with significant improvements in regional kyphosis angle,C_(2)~C_(7)angle and C_(0)~C_(2)angle.