摘要
目的对比头盆环牵引辅助后路截骨术与单纯后路截骨术治疗重度僵硬型脊柱畸形后脊柱侧凸及后凸角度变化。方法回顾分析2015年1月—2017年11月,收治的28例重度僵硬型脊柱畸形患者临床资料。其中16例采用头盆环牵引辅助后路截骨术(A组),12例采用单纯后路截骨术(B组)。两组患者性别、年龄、体质量指数、术前肺功能相关指标及主弯冠状面Cobb角、矢状面Cobb角、柔韧度等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间、术中出血量以及并发症发生情况。摄X线片测量两组术前(A组牵引前)、术后10 d、末次随访以及A组牵引后主弯冠状面和矢状面Cobb角。计算A组牵引后畸形改善率,两组术后畸形矫正率以及末次随访矫正丢失率。结果两组患者均获随访,随访时间24~30个月,平均26.5个月。与B组相比,A组手术时间明显缩短、术中出血量明显减少,差异均有统计学意义(t=7.629,P=0.000;t=8.773,P=0.000)。A组1例患者在持续牵引过程中出现一过性双下肢麻木,术后2例需要呼吸机支持至少12 h;B组7例需要呼吸机支持至少12 h,其中1例切口深部感染。A、B组并发症发生率分别为18.75%(3/16)和58.33%(7/12),差异有统计学意义(χ~2=4.680,P=0.031)。A组冠状面牵引后畸形改善率为40.47%±3.60%、矢状面为40.70%±4.20%。两组术后10 d及末次随访时冠状面及矢状面Cobb角、术后畸形矫正率以及末次随访矫正丢失率比较,差异均无统计学意义(P>0.05)。结论对于重度僵硬型脊柱畸形,头盆环牵引辅助或单纯后路截骨术矫形效果和术后畸形矫正维持效果相似,但联合头盆环牵引能缩短手术时间、降低术中出血量及减少并发症的发生。
Objective To compare the changes of scoliosis and kyphosis angles after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity.Methods A clinical data of 28 patients with severe rigid spinal deformity between January 2015 and November 2017 was retrospectively analyzed.Sixteen patients were treated by Halo-pelvic traction with posterior spinal osteotomy(group A)and 12 patients were treated with posterior spinal osteotomy only(group B).There was no significant difference between the two groups(P>0.05)in gender,age,body mass index,and preoperative pulmonary function,coronal and sagittal Cobb angles,and flexibility.The operation time,intraoperative blood loss,and complications were recorded.The coronal and sagittal Cobb angles were measured on X-ray films before operation(before traction in group A),at 10 days after operation,at last follow-up in the two groups and after traction in group A.The improvement rate of deformity after traction in group A,the correction rate of deformity after operation,and the loss rate of correction at last follow-up were calculated.Results All patients were followed up 24-30 months(mean,26.5 months).The operation time and intraoperative blood loss were significantly less in group A than in group B(t=7.629,P=0.000;t=8.773,P=0.000).In group A,1 patient occurred transient numbness of both legs during continuous traction and 2 patients needed ventilator support for more than 12 hours.In group B,7 patients needed ventilator support for more than 12 hours,including 1 patient with deep incision infection.The incidence of complications was 18.75%(3/16)in group A and 58.33%(7/12)in group B,and the difference between the two groups was significant(χ~2=4.680,P=0.031).The coronal and sagittal improvement rates of deformity after traction in group A were 40.47%±3.60%and 40.70%±4.20%,respectively.There was no significant difference between the two groups(P>0.05)in the coronal and sagittal Cobb angles at 10 days after operation and at last follow-up,in the correction rate of deformity after operation,and in the loss rate of correction at last follow-up.Conclusion For the severe rigid spinal deformity,Halo-pelvic traction with posterior spinal osteotomy and simple posterior spinal osteotomy can obtain the same orthopedic effect and postoperative deformity correction.However,the Halo-pelvic traction can shorten operation time,reduce blood loss and incidence of perioperative complications.
作者
欧阳北平
罗春山
马向阳
邹小宝
陆廷盛
陈啟鸰
蒲兴魏
OUYANG Beiping;LUO Chunshan;MA Xiangyang;ZOU Xiaobao;LU Tingsheng;CHEN Qiling;PU Xingwei(Department of Spine Surgery,Guizhou Provincial Orthopedics Hospital,Guiyang Guizhou,550004,P.R.China;Department of Orthopedics,General Hospital of Southern Theatre Command of Chinese PLA,Guangzhou Guangdong,510010,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第7期900-906,共7页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
重度僵硬型脊柱畸形
头盆环牵引
后路截骨术
Severe rigid spinal deformity
Halo-pelvic traction
posterior osteotomy
