后路截骨联合椎弓根内固定矫形治疗僵硬性脊柱侧后凸畸形

目的探讨经后路截骨联合椎弓根内固定矫形治疗僵硬性脊柱侧后凸畸形疗效。方法对26例僵硬性脊柱侧后凸畸形患者进行后路截骨、椎弓根内固定矫形。8例行后路Ponte截骨,13例行椎弓根截骨术(PSO)联合Ponte截骨,5例行全椎体切除术(VCR)。比较患者术前、术后和末次随访时Cobb角的变化及C7中垂线与骶骨中垂线距离的变化。结果患者均获得随访,时间12~60个月。侧凸Cobb角:术前30°~135°(90.7°±30.6°),术后12°~30°(18°±5.6°),矫正率为82.5%,末次随访13°~32°(20°±5.8°),丢失4.3%;后凸Cobb角:术前20°~60°(40.6°±18.5°),术后10°~26°(16.8°±6.2°),矫正率为85%,末次随访13°~30°(20.5°±7.0°),丢失3.7%;C7中垂线与骶骨中垂线距离:术前3.8~6.5(5.1±1.3)cm,术后0.3~1.3(0.7±0.3)cm,末次随访0.4~1.7(0.8±0.3)cm。所有患者未发生神经损伤等并发症,仅1例患者术后3个月出现内固定松动,经延长固定节段后骨性融合。结论术前充分的评估,选择合适的后路截骨方式,联合椎弓根内固定矫形治疗僵硬性脊柱侧弯,能有效矫正畸形和恢复脊柱冠、矢状面平衡。

Posterior osteotomy combined with pedicle screw fixation in the treatment of rigid kyphoscoli-osis

Objective To explore the effect of the posterior osteotomy combined with pedicle screw fixation in the treatment of rigid kyphoscoliosis. Methods Twenty-six cases of rigid kyphoscoliosis patients were treated with poste-rior osteotomy and pedicle internal fixation. Eight cases underwent posterior ponte osteotomy, 13 cases underwent pedicle subtraction osteotomy with ponte osteotomy, and 5 cases were treated with vertebral columm resection. The changes of Cobb angle and the changes of C7 perpendicular bisector of the sacrum and the perpendicular distance were compared before and after operation and at the last follow-up. Results All the patients were followed up for 12~60 months. Preoperative Cobb angle of scoliosis was 30° ~135°(90. 7° ± 30. 6°), postoperative Cobb angle correction was 12°~30°(18° ± 5. 6°), correction rate was 82. 5%;in the last follow-up, which was 13°~32°(20° ± 5. 8°), lost rate was 4. 3%. Cobb angle of kyphosis was 20°~60°(40. 6° ± 18. 5°), postoperative Cobb angle was 10°~26° (16. 8° ± 6. 2°),correction rate was 85%;in the last follow-up, which was 13°~30°(20. 5° ± 7. 0°),lost rate was 3. 7%;C7 perpendicular bisector of the sacrum and the perpendicular bisector distance was 3. 8~ 6. 5 (5. 1 ± 1. 3) cm preopratively, the postoperative was 0. 3 ~1. 3 ( 0. 7 ± 0. 3 ) cm. At the time of the last follow-up, which was 0. 4~1. 7 (0. 8 ± 0. 3) cm. In all cases,no nerve injury and other complications was found. Only in 1 case,3 months after the operation,there was a loosening of internal fixation and bone fusion after prolonged fixation. Conclusions Adequate preoperative evaluation, selection of appropriate posterior approach, combined with pedicle screw fixation in treatment of rigid kyphoscoliosis can effectively correct the deformity and restore the sagittal balance.