摘要目的 探讨应用扩大的经椎弓根椎体楔形截骨(expanding pedicle subtraction osteotomy,E-PSO)技术截骨矫形治疗先天性重度胸椎角状后凸畸形的可行性及其临床疗效.方法 回顾性分析2010年1月至2015年6月13例我院收治的先天性重度胸椎角状后凸畸形患者资料,男5例,女8例;年龄15～55岁,平均(34.9±20.5)岁.病变节段分布:T7～83例,T8～93例,T9～102例,T10～114例,T9～111例.术中使用E-PSO技术进行截骨矫形,将多个畸形椎体视为病椎复合体,在病椎复合体内两侧分别行楔形截骨,截骨平面下方与病椎复合体最邻近下一正常椎体的终板毗邻,截骨平面上方达病椎复合体最邻近上一正常椎体的终板毗邻,截骨完成后交替加压抱紧闭合.结果 所有病例均获得随访,随访时间10～42个月,平均32个月.术前节段后凸角为107.0°±3.5°,术后23.5°±1.5°,末次随访23.5°±0.2°.矢状面参数:术前胸椎后凸角(thoracic kyphosis,TK)为98.1°±7.6°,术后28.9°±3.0°,末次随访29.5°±0.1°;术前腰椎前凸角(lumbar lordosis,LL)为94.1°±1.5°,术后43.7°±1.3°,末次随访44.1°±5.3°;术前矢状面平衡(sagittal vertical axis,SVA)为(-0.6±39)mm,术后(1.6±7.9) mm,末次随访(6.0±0.7) mm.脊柱骨盆参数:术前骨盆入射角(pelvic incidence,PI)为28.9°±1.6°,术后31.7°±12.3°,末次随访31.9°±2.1°;术前骨盆倾斜角(pelvic tilt,PT)为17.7°±1.9°,术后13.4°±3.4°,末次随访13.1°±4.2°;术前骶骨倾斜角(sacral slope,SS)为11.3°±0.4°,术后18.2°±1.1 °,末次随访为18.7°±2.1°.术后及末次随访的矢状面参数、脊柱骨盆参数较术前均有明显改善,与术前相比,术后矢状面及脊柱骨盆各参数,除SVA外的差异均有统计学意义.至末次随访,均无明显矫正丢失,与术后相比,差异均无统计学意义.术前视觉模拟疼痛评分法(visual analogue scale,VAS)评分为(5.7±1.4)分,末次随访为(1.9±0.7)分;术前Oswestry功能障碍指数评分表(the Oswestry disability index,ODI)评分为(19.8±12.7)分,末次随访为(9.2±0.7)分.无一例无神经损害表现、感染等并发症,随访期间均未发现内固定的松动、脱出、移位和断裂.结论 对先天性重度胸椎角状后凸畸形的病例采用扩大PSO技术进行截骨矫形可行性较高并可以取得较好的疗效.

abstractsObjective To evaluate the clinical efficacy and feasibility of using the expanding pedicle subtraction osteotomy (E-PSO) technique for the treatment of congenital severe thoracic angular kyphotic deformity.Methods We retrospectively reviewed a cohort of 13patients with congenital severe kyphosis admitted to our hospital from January 2010 to June 2015 including 5 males and 8 females,the average age is (34.9±20.5) years old (ranged 15-55 years old).The vertebral deformity in T7～83 cases,T8～93 cases,T9～102 cases,T10～114 cases,T9～111 case.All cases were treated by E-PSO technique.The multi-malformed vertebrae are considered as a complexus.And the osteotomy was performed within the complexus.The superior and inferior endplate of the complexus were reserved.After the osteotomy was completed,alternately pressed tightly closed the upper and lower parts.Results All cases were followed up for 10-42 months,with an average of 32 months.At the time of preoperation,postoperation andthe last follow-up,the deformity angle was 107.0°±3.5°,23.5°± 1.5° and 23.5°±0.2°;TK was 98.1°±7.6°,28.9°±3.0° and 29.5°±0.1 °,LL was 94.1 °± 1.5°,43.7°± 1.3° and 44.1 °±5.3°;SVA was (-0.6±39) mm,(1.6±7.9) mm and (6±0.7) mm,respectively;PI was 28.9°±1.6°,31.7±12.3°and 31.9°±2.1°;PT was 17.7°±1.9°,13.4°±3.4°and 13.1°±4.2°,SS was 11.3°±0.4°,18.2°±1.1° and 18.7°±2.1°,respectively.The sagittal parameters and spinopelvic parameters except SVA were significantly improved in the post-operation and the last follow-up compared with the pre-operation according to the image data.No significant loss of correction occurred during the follow-up,and there was no statistical difference.The preoperative VAS score was (5.7± 1.4) points,ODI score was (19.8±12.7) points.The last follow-up VAS score was (1.9±0.7) points,the ODI score was (9.2±0.7) points.No case of nerve damage,infection and other complications,and no dissection,displacement and rupture of internal fixation were found during the follow-up.Conclusion The use of E-PSO technique for the treatment of congenital severe thoracic kyphotic kyphosis is feasible and can achieve better curative effect.