摘要目的 探讨后路Ponte截骨联合四棒交替加压矫形技术在休门氏病脊柱后凸畸形矫正中的应用效果及对降低术后矢状面矫正丢失的作用.方法 2012年7月至2014年9月接受Ponte截骨联合四棒交替加压矫形技术治疗的休门氏病脊柱后凸畸形患者17例,男15例,女2例;年龄14～23岁,平均(18.1±2.8)岁.术中完成后路多节段Ponte截骨矫形后,以后凸顶椎区为中心在顶椎截骨区两侧置入卫星棒,将双头钉槽与同侧的全长矫形棒连接成一体,交替加压抱紧进一步矫形.测量术前、术后及末次随访时最大后凸Cobb角(global kyphosis,GK)、矢状面平衡(sagittal vertical axis,SVA)、近端交界角(proximal junctional angle,PJA)和远端交界角(distal junctional angle,DJA).患者初诊及每次随访时均填写SF-36量表.结果 随访13～31个月,平均(14.9±4.2)个月.术前GK为66.7°±14.1°,术后为28.9°±8.1°,平均矫正率为56.2％±11.5％;末次随访时为29.4°±9.2°,未见明显矫正丢失.术前PJA为8.6°±4.2°,术后为10.3°±3.6°,末次随访时为10.5°±3.9°;术前DJA为7.6°±4.2°,术后为5.3°±3.3°,末次随访时为5.8°±2.7°.SVA由术前(-20.8±28.1)mm增加至术后(-16.7±19.5)mm,末次随访时为(-12.4±16.5)mm,无明显矫正丢失.全部患者均无神经损伤并发症,1例1枚螺钉突破上终板.随访期间未发生明显的矫形丢失、近端交界性后凸、远端交界性后凸、假关节形成和内固定失败等并发症.结论 应用Ponte截骨联合四棒交替加压矫形技术治疗休门氏病脊柱后凸畸形,满足坚强固定和应力分散的需要,术后早期矫形效果满意,矫正丢失和内固定相关并发症发生率低.

abstractsObjective To assess the effectiveness of multi-level Ponte osteotomies combined with four-rods compression in correcting Scheuermann's kyphosis (SK) via a posterior approach.Methods We retrospectively reviewed a consecutive cohort of 17 patients (15 males and 2 females) with SK who were treated with multi-level Ponte osteotomies combined with four-rods compression technique between July 2012 and September 2014.The mean age was 18.1±2.8 years old.Ponte osteotomy was routinely conducted around the apex region.Furthermore,bilateral satellite rods were implanted laterally to the main correction rods.The satellite rods and the main correction rods were collected via dual-head screws bilaterally.Gradual compression was applied by the four-rods complex to obtain maximal correction of kyphosis.The sagittal parameters,including global kyphosis (GK),sagittal vertical axis (SVA),proximal junctional angle (PJA) and distal junctional angle (DJA),were recorded at pre-operation,post-operation and at last follow-up.The MOS item short from health survey (SF-36) was conducted at pre-operation and at each follow-up to evaluate the clinical outcomes.Results The average follow-up duration was 14.9±4.2 (range,13-31) months.The pre-operative and post-operative GK was 66.7°± 14.1° and 28.9°±8.1° respectively,and the mean correction rate of Cobb angle was 56.2％± 11.5％.At the last follow-up,the average GK was 29.4°±9.2°.The average PJA increased from 8.6°±4.2° before surgery to 10.3°± 3.6° after surgery,and to 10.5°±3.9° at the last follow-up.The pre-operative,post-operative and last follow-up DJA were 7.6°± 4.2°,5.3°±3.3° and 5.8°±2.7°,respectively.The pre-operative,post-operative and last follow-up SVA were-20.8±28.1 mm,-16.7±19.5 mm and-12.4±16.5 mm,respectively.No significant correction loss or change in PJA or DJA was observed.Although one screw permeated the upper endplate,there was no neurological complication.The following complications,including correction loss,proximal junctional kyphosis,distal junctional kyphosis,pseudoarthrosis and implant-related complication,were not observed during follow-up.Conclusion Multi-level Ponte osteotomies combined with four-rods compression in correcting SK is effective in dispersing stress of each rod and in achieving satisfied clinical outcomes,as well as maintaining correction of kyphosis and preventing implant-related complications.