摘要
目的分析脊柱侧凸研究学会(Scoliosis Research Society)-Schwab 4级截骨与全脊椎截骨(vertebral column resection,VCR)治疗分节不良(Ⅱ型)所致先天性脊柱后凸畸形(congenital kyphosis,CK)的有效性和安全性。方法回顾性分析2008年6月至2021年12月在南京鼓楼医院接受矫形手术治疗的40例Ⅱ型CK患者资料,男15例、女25例,年龄(15.98±8.26)岁(范围5~47岁)。按术中截骨方式分为VCR组21例和SRS-Schwab 4级截骨组19例。记录两组患者的手术时间、估计出血量、未分节椎体数量、前路支撑cage使用情况。分析两组患者的融合节段数量、手术前后及末次随访时局部后凸角及其矫正度数和矫正率等影像学参数的差异。记录两组患者的并发症发生情况,包括神经电生理监护事件、神经损伤、内固定失败、近端交界性前凸或后凸(proximal junctional lordosis/kyphosis,PJL/PJK)、截骨闭合面矢状面偏移(sagittal translation,ST)。结果40例患者均获得随访,随访时间(48.96±21.31)个月(范围24~96个月)。VCR组涉及的分节不良节段较SRS-Schwab 4级截骨组[(3.85±0.79)个和(2.68±0.54)个]更长,相应的融合节段数[(8.00±2.23)个和(5.47±2.04)个]更多、手术时间[(358.71±77.06)min和(212.52±77.05)min]更长、估计出血量[(963.66±278.49)ml和(698.94±222.20)ml]更多,差异有统计学意义(P<0.05)。两组手术前后局部后凸角、矫正度数和矫正率的组间差异均无统计学意义(P>0.05)。随访时间≤48个月组中SRS-Schwab 4级截骨患者末次随访时局部后凸角(34.00°±21.37°和13.00°±16.28°)较小且局部后凸角矫正率(52.84%±24.67%和82.52%±21.40%)较高,差异有统计学意义(P<0.05);随访时间>48个月的患者中,VCR组和SRS-Schwab 4级截骨组间局部后凸角及其矫正率的差异无统计学意义(P>0.05)。随访期间两组影像学参数的差异均无统计学意义(P>0.05)。VCR组9例患者发生神经电生理监护事件1例次、神经损伤1例次、ST 2例次、PJK 3例次、PJL 1例次、内固定失败2例次、硬膜损伤2例次;SRS-Schwab 4级截骨组7例患者发生神经电生理监护事件1例次、神经损伤1例次、ST 2例次、PJK 4例次、内固定失败1例次、硬膜损伤1例次。总体并发症发生率的组间差异无统计学意义(χ^(2)=0.150,P=0.698)。SRS-22量表中自我形象维度,两组患者术后和末次随访时均较术前改善(P<0.05);功能维度,两组患者末次随访时均较术前改善,而SRS-Schwab 4级截骨组患者功能维度评分术后3个月即有改善(P<0.05)。结论SRS-Schwab 4级截骨可达到与VCR相似的矫形效果,而术中出血量、手术时间比VCR截骨术明显减少,两种矫形技术均可改善患者生活质量。
ObjectiveTo compare the efficacy and safety of SRS-Schwab grade 4 osteotomy and vertebral column resection(VCR)in the surgical correction of type Ⅱ congenital kyphosis(CK).MethodsA retrospective review was conducted on clinical and radiographic data from patients with type Ⅱ CK who underwent corrective surgery at Nanjing Drum Tower Hospital between June 2008 and December 2021.Patients were divided into two groups based on the osteotomy technique employed:the VCR group(21cases)and the SRS-Schwab grade 4 osteotomy group(19 cases).Clinical parameters,including operative duration,estimated blood loss(EBL),number of segmentation failure levels,number of fused segments,and the use of anterior support cages,were compared between groups.Radiographic parameters included the number of segmentation fusion and measurements of segmental kyphosis(SK)preoperatively,postoperatively,and at the final follow-up.The degree and rate of SK correction were also calculated and compared.Complications such as neurophysiological monitoring events,neurological injury,implant breakage,proximal junctional kyphosis/lordosis(PJK/PJL),sagittal translation(ST),and implant failure were recorded.Additionally,SRS-22 questionnaire scores were assessed preoperatively,postoperatively,and at the latest follow-up.ResultsA total of 40 patients were included,with a mean follow-up duration of 48.96±21.31 months(range,24-96 months).Compared to the SRS-Schwab group,the VCR group had significantly more levels of segmentation defect(3.85±0.79 vs.2.68±0.54),required more fused segments(8.00±2.23 vs.5.47±2.04),had longer operative time(358.71±77.06 min vs.212.52±77.05 min),and greater EBL(963.66±278.49 ml vs.698.94±222.20 ml),all with statistically significant differences(P<0.05).No significant differences were observed in local kyphotic angle,correction magnitude,or correction rate between groups postoperatively(P>0.05).Among patients with≤48 months of follow-up,the SRS-Schwab group showed significantly lower SK(13.00°±16.28°vs.34.00°±21.37°)and a higher correction rate(82.52%±21.40%vs.52.84%±24.67%)at final follow-up(P<0.05).However,no significant differences were observed in patients with>48 months of follow-up(P>0.05),or in the overall cohort regardless of follow-up duration(P>0.05).Complication rates were comparable between groups(P>0.05).One neurophysiological monitoring event,1 neurological injury,3 cases of PJK,1 case of PJL,2 cases of ST,and 2 implant failures were observed in VCR group.The SRS-Schwab Grade 4 osteotomy group had 1 neurophysiological monitoring event,1 neurological injury,4 cases of PJK,2 cases of ST,and 1 implant failure.The complication rates between the groups were not statistically different(P>0.05).Both groups showed significant improvements in the self-image domain of the SRS-22 postoperatively and at the final follow-up(P<0.05).In the function domain,both groups also demonstrated significant improvement at the final follow-up(P<0.05),while the SRS-Schwab group showed earlier improvement at 3 months postoperatively(P<0.05).ConclusionsSRS-Schwab grade 4 osteotomy provides comparable correction of segmental kyphosis to VCR but offers the advantages of significantly reduced blood loss and shorter operative time.Both surgical techniques effectively improve patients'quality of life.
作者
史本龙
马鸿儒
石博
孙旭
刘臻
朱泽章
邱勇
Shi Benlong;Ma Hongru;Shi Bo;Sun Xu;Liu Zhen;Zhu Zezhang;Qiu Yong(Division of Spine Surgery,Department of Orthopaedic Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)
出处
《中华骨科杂志》
北大核心
2025年第9期578-587,共10页
Chinese Journal of Orthopaedics
基金
江苏省医学创新中心(CXZX202214)。
关键词
脊柱后凸
先天畸形
截骨术
椎体
分节不良
Kyphosis
Congenital abnormalities
Osteotomy
Vertebral body
Failure of segmentation
