SRS-Schwab Ⅳ级截骨术治疗胸腰段创伤性后凸畸形患者术后疗效分析

Curative effect of SRS-Schwab grade 4 osteotomy in the treatment of post-traumatic thoracolumbar kyphosis

目的 探讨SRS-Schwab Ⅳ级截骨术治疗胸腰段创伤性后凸畸形(post-traumatic thoracolumbar kyphosis, PTK)患者的疗效。方法 回顾性分析2014年1月~2019年1月本院采用SRS-Schwab Ⅳ级截骨术治疗的90例PTK患者临床资料,记录手术时间、术中出血量、随访情况、并发症发生情况、生活质量,以及术前、术后2周和术后24个月时的影像学参数和临床指标。结果 手术时间140~235 min,平均(208.40±53.17)min,术中出血量为400~1200mL,平均(621.54±80.26) mL;术后切口均愈合良好。随访12~24个月,平均(12.53±2.16)个月,患者均获得良好的骨性融合。术后2周和术后24个月时胸椎后凸角(thoracic kyphotic, TK)、腰椎前凸角(lumbar lordosis, LL)、骶骨倾斜角(sacral slope, SS)显著高于术前,胸腰段Coob角、矢状面平衡距离(sagittal vertical axis, SVA)、骨盆倾斜角(pelvic tilt, PT)显著低于术前(P<0.05);且末次随访时胸腰段Coob角、TK、PT、SVA显著高于术后2周,SS、LL显著低于术后2周(P<0.05)。术后2周和术后24个月时VAS评分、ODI指数显著低于术前,且术后24个月时VAS评分、ODI指数显著低于术后2周(P<0.05)。术后24个月时,患者SRS-22评分中的疼痛、心理状况、自我形象、功能状况及对治疗的满意度评分显著高于术前(P<0.05)。3例患者出现并发症,2例麻痹性肠梗阻,1例双下肢短暂麻木,均给予对症支持治疗后恢复;所有患者随访期间未出现内固定松动、断裂等情况。结论 SRS-Schwab Ⅳ级截骨术治疗PTK患者疗效显著,可缓解疼痛程度,改善功能障碍,恢复矢状面平衡,提高生活质量,且安全性较高。

Objective To investigate the curative effect of Scoliosis Research Society(SRS)-Schwab grade 4 osteotomy in the treatment of patients with post-traumatic thoracolumbar kyphosis(PTK). Methods The clinical data of 90 patients with PTK treated with SRS-Schwab grade 4 osteotomy in the hospital from January 2014 to January 2019 were retrospectively analyzed. The operative time, intraoperative blood loss, follow-up, occurrence of complications, and quality of life were recorded, as well as imaging parameters and clinical parameters before operation, 2 weeks and 24 months after surgery. Results The operation time was 140-235 min, with an average of(208.40±53.17)min, and the intraoperative blood loss was 400-1200 mL, with an average of(621.54±80.26)mL. All incisions healed well after operation. The patients were followed up for 12-24 months, with an average of(12.53±2.16)months. All patients obtained good bone fusion. The thoracic kyphotic(TK), lumbar lordosis(LL), and sacral slope(SS) at 2 weeks and 24 months after operation were significantly higher than before operation, Cobb angle, sagittal vertical axis(SVA), and pelvic tilt(PT) were significantly lower than before operation(P<0.05). At the last follow-up, Cobb angle, TK, PT and SVA were significantly higher than those at 2 weeks after operation, SS and LL were significantly lower than those at 2 weeks after operation(P<0.05). The VAS scores and ODI scores at 2 weeks and 24 months after operation were significantly lower than before operation, and VAS scores and ODI scores at 24 months after operation were significantly lower than those at 2 weeks after operation(P<0.05). The scores of pain, psychological status, self-image, functional status, and satisfaction with treatment at 24 months after operation were significantly higher than before operation(P<0.05). Three patients developed complications, including 2 cases with paralytic intestinal obstruction, and 1 case with transient numbness of both lower extremities, all of whom were given symptomatic supportive treatment. At the last follow-up, the 3 patients all recovered. During postoperative follow-up period, no internal fixation loosening or breakage was observed. Conclusion SRS-Schwab grade Ⅳ osteotomy is effective in the treatment of patients with PTK. It can relieve pain, improve dysfunction, restore sagittal plane balance, and improve quality of life, with high safety.