基于CT影像学特征及手术治疗策略的北京大学第三医院先天性颈椎侧凸分型(PUTH-CCS分型)方法

Classification of congenital cervical scoliosis based on CT imaging features and surgical strategies: PUTH-CCS classification

目的:提出北京大学第三医院先天性颈椎侧凸分型(PUTH-CCS分型)方法,探讨其对先天性颈椎侧凸手术策略制定的指导意义。方法:根据颈椎侧凸节段中责任畸形椎的形态、责任畸形椎所在区域及其与邻近椎骨的关系,提出分型方法。回顾2009年5月至2022年5月收治的先天性颈椎侧凸畸形患者57例,分析每例患者的术前CT影像学资料以及采用的手术策略并总结二者之间的关系,将以上3个要素进行整合,从而建立先天性颈椎侧凸畸形解剖学特征与手术策略制定之间的联系。结果:根据畸形椎骨形态,将半椎骨畸形、楔形椎畸形和不对称的蝴蝶椎畸形分别记录为Ⅰ、Ⅱ、Ⅲ型;根据畸形椎骨所在区域,将颅颈交界区(O~C2)、下颈椎区域(C2~C6)以及颈胸交界区(C6~T2)分别记录为a、b、c型;根据畸形椎骨与上下相邻椎骨的关系,按照完全分节、半分节和未分节依次记录为F、S、N。当半分节椎与上相邻椎融合时记录为SU,与下相邻椎融合时记录为SL。在凸侧切除术中,Ⅰ型采用完全切除术,Ⅱ型和Ⅲ型采用部分切除术;F型采用从椎间盘间隙进行手术操作,S型和N型需要先在阻滞椎之间截骨、再切除椎骨的楔形部分。在凹侧撑开术中,F型和SU型可在畸形椎所在间隙凹侧撑开;N型和SL型可在下方相邻椎间隙内凹侧撑开。在两种术式中,a型采用单纯后入路的手术方式,b型和c型采用前-后-前联合入路的手术方式。在下颈椎区域,多采用短节段固定;在颅颈、颈胸交界区,多采用长节段固定。结论:PUTH-CCS分型可以较好地反映各畸形椎的临床特点,指导不同分型的畸形椎的手术治疗方式,为今后手术治疗先天性颈椎侧凸手术策略的制定提供参考和指导。

Objective: To propose the Peking University Third Hospital classification of congenital cervical scoliosis(PUTH-CCS classification). Methods: PUTH-CCS classification method was proposed according to the shape and location of the responsible malformed vertebra and its relationship with the adjacent vertebrae. A total of 57 patients with congenital cervical scoliosis admitted to our hospital from May 2009 to May 2022 were reviewed. Preoperative CT imaging data and surgical strategies of each patient were analyzed and the relationship between them was summarized. Results: According to the shape of malformed vertebrae, hemivertebra deformity, wedge vertebra deformity and asymmetric butterfly vertebra deformity were recorded as type Ⅰ, Ⅱ and Ⅲ, respectively.According to the location of malformed vertebrae, craniocervical junction(O-C2), lower cervical spine(C2-C6) and cervicothoracic junction(C6-T2) were recorded as type a, b and c, respectively. According to the relationship between the malformed vertebrae and the upper and lower adjacent vertebrae, the fully segmented, semi-segmented and nonsegmented vertebrae were recorded as type F, S and N, respectively. SUwas recorded when semi-segmented vertebrae fused with the upper adjacent vertebrae, and SLwas recorded when semi-segment vertebrae fused with the lower adjacent vertebrae. In convex-resection technique, complete resection was performed for type Ⅰ and partial resection was performed for type Ⅱ and Ⅲ deformities. For type F, surgery was performed from the intervertebral disc space. For type S and N, osteotomy was performed between blocked vertebrae and then the wedge-shaped portion of the vertebrae was removed. In the concave-distraction technique, type F and SUcould be divided on the concave side of the gap where the malformed vertebrae was located;type N and SLvertebrae could be divided on the concave side of the adjacent lower intervertebral space. A simple posterior approach was used in type a, while a combined anterior-posterior-anterior approach was used in type b and c. In the lower cervical vertebrae, short fixation was preferred, while in the craniocervical and cervicothoracic junction, long fixation was preferred.Conclusions: PUTH-CCS classification can reflect the clinical features of various vertebral malformations, guide the surgical treatment of different types of malformed vertebrae, and provide reference and guidance for the development of surgical strategies for the treatment of congenital cervical scoliosis.