后路多节段Ponte截骨矫形固定术治疗青少年休门氏脊柱后凸畸形疗效分析

Posterior-only multi-segment Ponte osteotomies with internal fixation and fusion in adolescent Scheuermann s kyphosis

目的评价后路多节段Ponte截骨矫形固定术治疗青少年休门氏脊柱后凸畸形(scheuerman s disease,SK)的手术效果及对脊柱-骨盆矢状位参数的影响。方法回顾性分析2012年7月至2018年12月首都医科大学附属北京儿童医院诊治的18例青少年SK患者的临床资料,其中男14例,女4例;年龄11~15岁,平均(13.2±1.9)岁。所有患者接受后路多节段Ponte截骨矫形固定手术,随访时间至少24个月。术前、术后及末次随访时所有患者行站立位全脊柱正侧位X线检查。对比术前、术后以及末次随访时全脊柱最大后凸角(global kyphosis,GK)、近端交界角(proximal junctional angle,PJA)、远端交界角(distal junctional angle,DJA)、胸椎后凸(thoracic kyphosis,TK)、腰椎前凸(lumbar lordosis,LL)、矢状面平衡(sagittal vertical axis,SVA)以及骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)的变化。结果随访24~70个月,平均(38.10±15.32)个月;Ponte截骨节段为6~9个,平均(7.4±1.1)个;术后即刻GK较术前明显降低(P<0.05),由术前的(78.3±10.6)°下降至术后即刻的(32.3±8.4)°,术后即刻矫正率达58.7%,末次随访时为(34.1±6.2)°,与术后即刻无明显差异(P>0.05);术后即刻TK、LL较术前降低(P<0.05),与末次随访时比较差异无统计学意义(P>0.05)。PJA、DJA、SVA及骨盆矢状位参数(PI、PT、SS),术后即刻、末次随访时与术前比较差异均无统计学意义(P>0.05)。所有患者无神经系统并发症。矫形手术对脊柱-骨盆矢状位序列无明显影响。随访过程中未见近端交界性后凸、远端交界性后凸,无内固定失败、感染和假关节形成等并发症。结论后路多节段Ponte截骨矫形固定术治疗青少年SK安全、有效,至少2年随访结果是满意的,此类手术并不影响脊柱-骨盆矢状位参数。

Objective To evaluate the surgical outcomes of posterior-only multi-segment Ponte osteotomies with internal fixation and fusion for adolescent Scheuermann s kyphosis(SK).Methods Clinical data were retrospectively reviewed for 18 undergoing posterior-only multi-segment Ponte osteotomies with internal fixation and fusion from July 2012 to December 2018.There are 14 boys and 4 girls with an average age of(6.50±3.22)(2.17-13.00)years.Standing anteroposterior and lateral radiographs of full-spine were recorded and compared preoperatively,postoperatively and at the last follow-up.Radiographic parameters included global kyphosis(GK),proximal junctional angle(PJA),distal junctional angle(DJA),thoracic kyphosis(TK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT)and sacral slope(SS).Results The mean follow-up period was(38.10±15.32)(24-70)months.Ponte osteotomy segments had an average of(7.4±1.1)(6-9).GK was(78.3±10.6)°preoperatively,(32.3±8.4)°(correction rate of 58.7%)postoperatively and(34.1±6.2)°at the latest follow-up.TK and LL post-operation were significantly lower than those pre-operation(P<0.05)and there was no significant difference from the last follow-up(P>0.05).PJA,DJA,SVA and sagittal spinopelvic parameters(PI/PT/SS)were not significantly different from those pre-operation and the last follow-up(P>0.05).There was no occurrence of neurologic complication,proximal junctional kyphosis,distal junctional kyphosis,infection,pseudarthrosis,correction loss or instrumentation-related complication during follow-ups.Conclusion Posterior-only multi-segment Ponte osteotomies with internal fixation and fusion is both safe and effective for adolescent SK.And surgical outcomes were satisfactory during a follow-up period of over 2 years.In our experience,the spinopelvic parameters did not change after surgery.