摘要
目的探讨不同亚型"Ω"型严重脊柱侧后凸患者矫形手术的临床疗效。方法回顾性分析2010年8月至2020年7月在南京鼓楼医院接受矫形手术治疗的79例"Ω"型严重脊柱侧后凸患者的资料,男37例、女42例,年龄(21.4±7.4)岁(范围8~52岁)。33例为先天性脊柱侧凸、27例为特发性脊柱侧凸、9例为马方综合征、8例为神经纤维瘤病、2例为神经肌源性疾病。根据"Ω"型严重脊柱侧后凸亚分型分为2P型58例、2D型13例和2PD型8例。采用侧凸Cobb角、后凸Cobb角、脊柱侧凸研究学会-22简明量表调查问卷(Scoliosis Research Society questionnaires-22,SRS-22)、Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉模拟评分(visual analog scale,VAS)评估矫正效果及临床功能。结果所有患者均顺利完成手术,Halo重力牵引时间为(72.6±27.5)d(范围14~150 d)。所有患者均获得随访,随访时间为(27.5±3.9)个月(范围24~40个月)。2P组侧凸牵引效果为18.7°±12.4°、后凸牵引效果为19.5°±14.0°;2D组侧凸牵引效果为26.0°±12.5°、后凸牵引效果为10.1°±7.9°;2PD组侧凸牵引效果为13.4°±5.7°、后凸牵引效果为8.3°±5.9°。2P组术前侧凸Cobb角为128.9°±29.1°、术后为84.5°±24.5°、末次随访时为87.7°±25.0°,矫正率为34%±12%;术前后凸Cobb角为112.9°±27.1°、术后为77.6°±22.9°、末次随访时为80.2°±22.8°,矫正率为30%±16%。2D组术前侧凸Cobb角为113.1°±19.9°、术后为71.2°±16.3°、末次随访时为73.8°±16.3°,矫正率为37%±11%;术前后凸Cobb角为87.2°±14.0°、术后为61.6°±18.5°、末次随访时为65.1°±18.5°,矫正率为31%±22%。2PD组术前侧凸Cobb角为119.6°±29.0°、术后为78.3°±20.8°、末次随访时为87.0°±23.0°,矫正率为35%±8%;术前后凸Cobb角为124.6°±16.8°、术后为82.1°±19.9°、末次随访时为90.9°±16.9°,矫正率为33%±16%。末次随访时三组患者的SRS-22四个维度评分均较术前提高,其中2PD组疼痛、自我形象维度评分手术前后的差异无统计学意义(P>0.05),其余各维度手术前后的差异均有统计学意义(P<0.05);术前和末次随访时三组间的差异均无统计学意义(P>0.05)。结论"Ω"型严重脊柱侧后凸患者经Halo重力牵引及脊柱矫形手术治疗可以改善脊柱畸形,其中2PD型患者的牵引效果和矫形术后恢复情况较差。
Objective To evaluate the clinical outcomes of corrective surgery in patients with different subtypes of"Ω"-type severe scoliosis.Methods A retrospective analysis was conducted on 79 patients with"Ω"-type severe scoliosis treated at Nanjing Drum Tower Hospital from August 2010 to July 2020.The cohort included 37 males and 42 females,with a mean age of 21.4±7.4 years(range,8-52 years).The mean duration of preoperative halo traction was 72.6±27.5 days(range,14-150 days).Etiologies included congenital scoliosis(33 cases),idiopathic scoliosis(27 cases),Marfan syndrome(9 cases),neurofibromatosis(8 cases),and neuromuscular disorders(2 cases).Based on the classification by Karikari et al.,58 patients were classified as type 2P,13 as type 2D,and 8 as type 2PD.Outcome measures included coronal and kyphotic Cobb angles,the Scoliosis Research Society-22(SRS-22)questionnaire,Oswestry disability index(ODI),and visual analog scale(VAS).Results All surgical procedures were successfully completed,and all patients were followed up for an average of 27.5±3.9 months(range,24 to 40 months).The duration of Halo gravity traction was 72.6±27.5 days(range,14-150 days).In the 2D group,the changes after traction were 26.0°±12.5°for the coronal Cobb angle and 10.1°±7.9°for the kyphotic Cobb angle.In the 2PD group,the traction effect was 13.4°±5.7°for the coronal and 8.3°±5.9°for the kyphotic Cobb angle.In the 2P group,the preoperative coronal Cobb angle was 128.9°±29.1°,postoperative was 84.5°±24.5°,and at the last follow-up was 87.7°±25.0°,yielding a correction rate of 34%±12%.The kyphotic Cobb angle in this group changed from 112.9°±27.1°preoperatively to 77.6°±22.9°postoperatively,and 80.2°±22.8°at the final follow-up,corresponding to a correction rate of 30%±16%.In the 2D group,the coronal Cobb angle was 113.1°±19.9°preoperatively,71.2°±16.3°postoperatively,and 73.8°±16.3°at the final follow-up,with a correction rate of 37%±11%.The kyphotic Cobb angle in this group was 87.2°±14.0°preoperatively,61.6°±18.5°postoperatively,and 65.1°±18.5°at the final follow-up,with a correction rate of 31%±22%.In the 2PD group,the coronal Cobb angle improved from 119.6°±29.0°preoperatively to 78.3°±20.8°postoperatively,and 87.0°±23.0°at the last follow-up,corresponding to a correction rate of 35%±8%.The kyphotic Cobb angle in this group was 124.6°±16.8°preoperatively,82.1°±19.9°postoperatively,and 90.9°±16.9°at the final follow-up,with a correction rate of 33%±16%.At the last follow-up,SRS-22 scores across all four domains had improved in all three groups compared to preoperative values.In the 2PD group,however,the differences in the pain and self-image domains before and after surgery were not statistically significant(P>0.05),while improvements in the other domains were significant(P<0.05).No statistically significant differences were observed among the three groups either preoperatively or at the final follow-up(P>0.05).ConclusionCombined Halo-gravity traction and spinal corrective surgery are effective in improving both radiographic and functional outcomes in patients with"Ω"-type severe scoliosis.Nonetheless,patients in the 2PD subtype demonstrate reduced traction responsiveness and relatively limited postoperative recovery compared to the 2P and 2D subtypes.
作者
刘昌伟
李劼
徐辉
胡宗杉
许彦劼
刘臻
邱勇
朱泽章
Liu Changwei;Li Jie;Xu Hui;Hu Zongshan;Xu Yanjie;Liu Zhen;Qiu Yong;Zhu Zezhang(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15期967-976,共10页
Chinese Journal of Orthopaedics
基金
江苏省333高层次人才培养工程((2022)3-1-128)
江苏省医学创新中心(CXZX202214)。
