摘要
目的探讨Ponte截骨联合卫星棒序贯矫形技术在治疗重度僵硬性胸椎侧后凸畸形中的疗效及安全性。方法回顾性分析2012年10月至2016年10月在鼓楼医院接受后路Ponte截骨联合卫星棒序贯矫形技术治疗的主弯>100°且随访2年以上重度僵硬性胸椎侧后凸畸形的32例患者资料,其中男12例,女20例,年龄17~46岁,平均(21.3±10.8)岁。评估术前、术后以及末次随访时主弯Cobb角、胸椎局部后凸角、冠状面顶椎偏移距离、矢状面躯干偏移距离等影像学指标,记录术中术后并发症发生率。应用SRS-22量表评估临床疗效。结果术前冠状面主弯Cobb角平均117.8°±9.8°(104°~131°),平均柔韧性为13.9%;胸椎局部后凸角平均65.5°±18.7°(48°~87°)。手术时间平均(267.4±42.3)min,术中出血量平均(895.4±103.1)ml。本组患者固定节段在T2~L4之间,平均固定(13.3±2.4)个节段,平均置钉密度为62.1%±8.8%,术中Ponte截骨节段4~9个,平均(6.1±1.9)个。术后主弯Cobb角平均为54.4°±10.9°,平均矫正率为53.9%±9.3%,胸椎后凸角矫正到35.6°±12.0°,均较术前显著改善(t主弯Cobb角=24.468,P主弯Cobb角=0.000;t胸椎后凸角=7.612,P胸椎后凸角=0.000)。本组患者平均随访时间为(34.3±8.9)个月,末次随访主弯Cobb平均53.1°±1.9°,平均矫正丢失为1.3°,胸椎后凸角为36.7°±11.4°。术中及术后未见神经损伤、内固定失败等并发症。结论Ponte截骨联合卫星棒序贯矫形技术治疗重度僵硬性胸椎侧后凸畸形可获得较好的矫形效果,且远期随访矫正丢失少,是一种安全而有效的手术策略。
Objective To investigate the efficacy and safety of Ponte osteotomy and sequential correction technique with satellite rod construction in the treatment of severe rigid thoracic scoliosis.Methods A total of 32 patients(12 male,20 female)with severe rigid thoracic scoliosis(Cobb angle>100°)who underwent posterior Ponte osteotomy and sequential correction technique with satellite rod construction between October 2012 and October 2016 and with more than 2 years follow-up were retrospectively reviewed.Major curve Cobb angle,apex vertebral translation,trunk shift,thoracic kyphosis and lumbar lordosis were measured through standing posterior-anterior X-ray preoperatively,postoperatively and at the final follow-up.The duration of operation,blood loss and complications were recorded.SRS-22 questionnaire was used to evaluate the clinical outcomes.Results The average age was 21.3±10.8 years(range from 17 to 46 years).The mean preoperative major curve Cobb angle was 117.8°±9.8°(range from 104°to 131°)with a mean flexibility of 13.9%and the mean thoracic kyphosis was 65.5°±18.7°(range from 48°to 87°).The mean duration of operation was 267.4±42.3 min and the mean blood loss was 895.4±103.1 ml.The mean fused levels ranged from T2 to L4 with a mean 13.3±2.4 fused segments.The mean implant density was 62.1%±8.8%.Ponte osteotomy was performed in 4-9 segments which was 6.1±1.9 segments in average.The coronal main curve was corrected to 54.4°±10.9°with a mean correction rate of 53.9%±9.3%and the mean thoracic kyphosis was corrected to 35.6°±12.0°,which were both significantly improved.The average follow-up time was 34.3±8.9 months.At the last follow-up,the mean coronal main curve was 53.1°±1.9°with a mean correction loss of 1.3°and the thoracic kyphosis was 36.7°±11.4°.There were no neurological deficit or implant failure postoperatively and follow-up.Conclusion Ponte osteotomy followed by sequential correction technique with satellite rods construction was safe and effective which could achieve satisfactory correction rate and less correction loss during the longitudinal follow-up in the treatment of severe rigid thoracic scoliosis.
作者
李洋
史本龙
刘臻
孙旭
王斌
朱泽章
邱勇
Li Yang;Shi Benlong;Liu Zhen;Sun Xu;Wang Bin;Zhu Zezhang;Qiu Yong(Department of Spine Surgery,Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2019年第22期1357-1364,共8页
Chinese Journal of Orthopaedics
基金
江苏省博士后科研资助计划(1701018C)
江苏省自然科学基金青年基金(BK20170126)
中国博士后科学基金面上资助(2017M610323)。
关键词
胸椎
脊柱侧凸
截骨术
矫形外科手术
Thoracic vertebrae
Scoliosis
Osteotomy
Orthopedic procedures
