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后路椎间隙侧方松解辅助下经关节突截骨术治疗胸腰椎后凸畸形的效果分析

Efficacy analysis of Smith-Petersen osteotomy assisted by releasing disk space from posterior approach for thoracolumbar kyphosis

摘要:

目的 探讨后路椎间隙侧方松解辅助下经关节突截骨术(SPO)矫正胸腰椎后凸畸形的有效性及安全性.方法 对北京大学第三医院骨科2016年6月至2017年9月采用后路椎间隙侧方松解辅助下SPO治疗的8例胸腰椎后凸畸形患者临床资料进行回顾性分析.8例患者中,男性3例,女性5例;年龄56.5岁(范围:18~ 71岁);休门病后凸患者3例,退变性后凸患者2例,腰椎内固定术后近端交界区后凸患者1例,胸腰段椎板切除术后后凸患者2例.评价指标为手术前后胸腰椎后凸角、截骨节段后凸角、矢状面平衡值(SVA)等影像学指标及疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数问卷表评分(ODI),采用配对样本t检验进行统计学分析.结果 8例患者截骨部位分别为T11~12者2例、T12~L1者3例、L1~2者3例;手术时间339 min(范围:247~ 416 min);出血量1 275 ml(范围:500~2 500 ml);随访时间16.5个月(范围:12~ 24个月).8例患者术前胸腰椎后凸角为59.9°(范围:40°~73°),术后为9.5°(范围:-5.1°~20°),末次随访时为13.5°(范围:-1.3°~28°),平均矫正46.4°,矫正率78.0%;术前截骨节段后凸角为37.9°(范围:26°~46°),术后即刻为-1.3°(范围:-11°~13°),截骨节段椎体间隙平均张开39.2°,末次随访时为2.0°(范围:-13.5°~13°);术前腰椎前凸角为47.5°(范围:2°~76°),术后即刻为41.2°(范围:15°~62°),末次随访时为36.9°(范围:15°~58°);术前SVA为54 mm(范围:-34~149 mm),末次随访时为39 mm(范围:-3~119 mm);术前VAS为6.3分(范围:0~9分),末次随访时为3.0分(范围:0~6分);术前ODI评分为21.9分(范围:0~42分),末次随访时为11.0分(范围:0~26分).末次随访时与术前相比,胸腰段后凸角(t=8.547,P=0.000)、截骨水平相邻椎体后凸角(t=9.739,P=0.000)、VAS评分(t=3.077,P=0.018)、ODI评分(t=5.800,P=0.001)的差异有统计学意义.本组8例患者均未发生神经功能损伤并发症,2例既往有脊柱手术史的患者因术中剥离瘢痕与硬脊膜的粘连致硬脊膜出现裂口并发脑脊液漏,经对症处理后痊愈.结论 对于40°左右的僵硬性胸腰椎后凸畸形采用经后路椎间隙侧方松解辅助下SPO可实现安全有效的畸形矫正.

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abstracts:

Objective To evaluate the efficacy and safety of Smith-Petersen osteotomy (SPO) assisted by releasing disk space from posterior approach for thoracolumbar kyphosis.Methods A review was conducted on 8 patients (3 males and 5 females) with thoracolumbar kyphosis were treated with SPO assisted by releasing disk space from posterior approach at Department of Orthopaedics,Peking University Third Hospital from June 2016 to September 2017.The age was 56.5 years (range:18-71 years).There were 3 cases of Scheuermanns kyphosis,2 cases of degenerative kyphosis,1 case of proximal junctional kyphosis (PJK) after lumbar surgery,and 2 cases of kyphosis after thoracolumbar laminectomy.The paired t test was used for statistical analysis in thoracolumbar kyphosis angle,osteotomy segment kyphosis angle,sagittal vertical value (SVA),visual analogue score (VAS),Oswestry dysfunction index (ODI) before and after surgery.Statistical difference was confirmed with P<0.05.Results Osteotomy level included 2 cases in T,-12,3 cases in T12-L1,3 cases in L1-2.The average operation time was 339 min (range:247-416 min),bleeding volume was 1 275 ml (range:500-2 500 ml).The mean follow-up time was 16.5 months (range:12-24 months).The average thoracolumbar kyphosis angle was 59,9° (range:40°-73°) pre-operation,9.5°(range:-5.1°-20°) post-operation and 13.5°(range:-1.3°-28°) at the latest follow-up.It made an average correction with 46.4°and corrective rate with 78.0%.The osteotomy segment kyphosis angle was 37.9° (range:26°-46°) pre-operation,-1.3° (range:-11°-13°) post-operation making an 39.2° open-up angle,and 2.0°(range:-13.5°-13°) at the latest follow-up.Lumbar lordosis was 47.5°(range:2°-76°) pre-operation,41.2°(range:15°-62°) post-operation and 36.9°(range:15°-58°) at the latest follow-up.SVA was 54 mm(range:-34 mm-149 mm) pre-operation and 39 mm(range:-3 mm-119 mm) at the latest follow-up.VAS score of low back pain was 6.3(range:0-9) pre-operation and 3.0(range:0-6) at the latest follow-up.ODI score was 21.9(range:0-42) pre-operation and 1 1.0(range:0-26) at latest follow-up.Comparing to pre-operation value,there were statistical difference in the thoracolumbar kyphosis angle(t=8.547,P=0.000),osteotomy segment kyphosis angle(t=9.739,P=0.000),VAS(t=3.077,P=0.018),ODI(t=5.800,P=0.001) at the latest follow-up.There was no neuropathic complication in all patients.Cerebrospinal fluid leakage occurred in 2 cases with spinal surgery history,and recovered after symptomatic treatment.Conclusions SPO assisted by releasing disk space from posterior approach could safely achieve effective correction of rigid thoracolumbar kyphosis deformity within 40°.

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作者: 钟沃权 [1] 陈仲强 [1] 曾岩 [1] 孙垂国 [1] 李危石 [1]
第一作者: 钟沃权
期刊: 《中华外科杂志》2019年57卷5期 337-341页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2019.05.004
发布时间: 2019-06-06
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