顶椎区多棒矫形联合远端脊柱后柱截骨治疗重度特发性脊柱侧凸的疗效分析

Efficacy of Apical Multi-Rods Correction Combined with Distal Posterior Column Osteotomy in the Treatment of Severe Idiopathic Scoliosis

目的 探讨顶椎区多棒矫形联合远端脊柱后柱截骨术(posterior column osteotomy,PCO)治疗重度特发性脊柱侧凸的临床疗效及安全性。方法 回顾性分析我院2014年2月至2020年2月行后路手术、随访时间超过2年的重度特发性脊柱侧凸(Cobb角≥90°)病人共48例,所有病人均行远端PCO截骨,依据矫形情况分为顶椎区多棒矫形组(21例)和传统双棒矫形组(27例),在术前、术后和末次随访时进行影像学和脊柱侧凸研究学会-22简明量表调查问卷(Scoliosis Research Society questionnaires-22,SRS-22)评估,比较两组的影像学参数、手术时间、出血量和并发症等,分析其疗效和安全性。结果 双棒矫形组随访(37.2±8.8)个月,多棒矫形组随访(31.6±7.6)个月。传统双棒矫形组手术时间为(430.8±79.1) min,长于多棒矫形组的(331.2±97.3) min,差异有统计学意义(P=0.037)。两组病人术后冠状面和矢状面参数均较术前显著改善,差异有统计学意义(P <0.05)。末次随访时,多棒矫形组的矢状面矫形丢失显著高于双棒矫形组(3.7°±0.9°vs.2.3°±1.0°),椎弓根螺钉拔出发生率显著低于双棒矫形组(4.8%vs.29.6%),差异有统计学意义(P<0.05)。结论 与传统双棒比较,顶椎区多棒矫形技术联合远端PCO截骨具有相似的矫形效果,手术流程更简便,术中螺钉拔出率低,对于重度特发性脊柱侧凸,是一种安全有效的手术方法,但矢状面矫形丢失需要长期随访关注。

Objective To investigate the clinical efficacy and safety of apical multi-rods correction combined with distal posterior column osteotomy(PCO)in the treatment of severe idiopathic scoliosis.Methods Retrospective analysis was performed on 48 severe idiopathic scoliosis patients(Cobb Angle≥90°)who received posterior spinal surgery at our center from February 2014 to February 2020,with a follow-up time of more than 2 years.All patients underwent PCO.According to the method of correction,there were 21 cases in apical multi-rods(MR)group and 27 cases in traditional double-rods(DR)group.The data of radiographic image and Scoliosis Research Society questionnaires-22(SRS-22)scale were collected before operation,after operation and at the final follow-up.Radiographic parameters,operation time,blood loss and complications were compared between two groups to analyze the efficacy and safety.Results The follow-up time was(31.6±7.6)months in MR group and(37.2±8.8)months in DR Group.The operation time in the MR group was significantly shorter than that in the DR Group(331.2±97.3 min vs.430.8±79.1 min,P=0.037).After the operation,all patients achieved significant improvement in both coronal and sagittal parameters(P<0.05).At the final follow-up,the loss of sagittal correction in the MR group was significantly greater than that in the DR group(3.7°±0.9°vs.2.3°±1.0°,P<0.05).The incidence of pedicle screw pulled-out in the MR group was significantly lower than that in the DR Group(4.8%vs.29.6%,P<0.05).Conclusion Compared with traditional double-rods technique,multi-rods technique combined with distal PCO offers similar effects of correction,with a simpler operative process and a lower incidence of pedicle screw pulled-out.Multi-rods correction combined with distal PCO is a safe and effective method for severe idiopathic scoliosis patients.However,the loss of sagittal correction requires long-term concern.