保留中柱经椎弓根开合式截骨术治疗脊柱后凸畸形的近远期效果及对矢状面参数的影响

The Short-Term and Long-Term Eficacy of Preserving the Middle Column and Transpedicular Open and Close Osteotomy for the Treatment of Kyphosis Deformity and Its Impact on Sagittal Plane Parameters

目的:探讨与分析保留中柱经椎弓根开合式截骨术治疗脊柱后凸畸形的近远期效果及对矢状面参数的影响。方法:选择2019年8月-2022年10月我院收治的76例脊柱后凸畸形患者为研究对象,根据1:1随机掷硬币原则将其分为试验组与对照组,各38例。2组均采用截骨手术治疗,对照组采用经椎弓根开合式截骨术治疗,试验组采用保留中柱经椎弓根开合式截骨术治疗。观察与判定患者的近远期疗效,测定矢状面参数变化情况。结果:2组的手术时间对比,差异无统计学意义(P>0.05);试验组术中出血量、术后引流量均少于对照组,术后引流时间、术后住院时间均短于对照组,组间差异有统计学意义(P<0.05);术后3个月,2组VAS评分、ODI指数均低于术前1d,且试验组低于对照组,差异有统计学意义(P<0.05);试验组并发症发生率低于对照组,差异有统计学意义(P<0.05);术后3个月,2组Cobb角均小于术前1d,且试验组小于对照组,差异有统计学意义(P<0.05)。结论:保留中柱经椎弓根开合式截骨术治疗脊柱后凸畸形并不会增加手术难度,还可促进患者康复,缓解患者的疼痛,改善患者的腰椎功能,可改善患者的矢状面参数,降低患者的术后并发症发生率。

Objective:To explore and analyze the short-term and long-term efficacy of preserving the middle column and transpedicular open and close osteotomy in the treatment of kyphosis deformity and its impact on sagittal plane parameters.Methods:76 patients with kyphosis deformity admitted to our hospital from August 2019 to October 2022 were selected as the research subjects,According to the 1:1 random coin toss principle,they were divided into an experimental group and a control group,with 38 cases in each group.Both groups were treated with osteotomy,the control group was treated with transpedicular open and close osteotomy,and the experimental group was treated with transpedicular open and close osteotomy preserving the middle column.The short-term and long-term therapeutic effects of patients were observed and assessed,and changes in sagittal plane parameters were measured.Results:Comparison of surgical time between two groups,the difference was not statistically significant(P>0.05);the intraoperative bleeding volume and postoperative drainage volume in the experimental group were lower than those in the control group,and the postoperative drainage time and hospitalization time were shorter than those in the control group,with statistically significant(P<0.05);three months after surgery,the VAS score and ODI index of both groups were lower than those of the preoperative day 1,and the experimental group was lower than the control group,with statistically significant(P<0.05);the incidence of complications in the experimental group was lower than that in the control group,with statistically significant(P<0.05);three months after surgery,both groups had Cobb angles smaller than 1 day before surgery,and the experimental group was smaller than the control group,with statistically significant(P<0.05).Conclusion:Preserving the central column and transpedicular open and close osteotomy for the treatment of spinal kyphosis does not increase surgical difficulty.It can also promote patient recovery,alleviate pain,improve lumbar function,improve sagittal plane parameters,and reduce the incidence of postoperative complications.