Voos K, Boachie-Adjei O, Rawlins B A
Scoliosis Service, The Hospital for Special Surgery, New York, New York 10021, USA.
Spine (Phila Pa 1976). 2001 Mar 1;26(5):526-33. doi: 10.1097/00007632-200103010-00016.
Retrospective review of the clinical and radiographic results in adult revision spine deformity surgery using the techniques of osteotomies to effect spine balance and curve correction.
To assess the efficacy of multiple vertebral osteotomies in correction of rigid spine deformities in adult patients undergoing revision surgery.
The records and radiographs of 27 adult patients with idiopathic scoliosis who underwent revision surgery requiring anterior release (discectomy and/or osteotomy) and posterior osteotomy to correct rigid spinal deformities were retrospectively reviewed.
All 27 patients were available for follow-up evaluation. Fifteen patients had anterior discectomies followed by posterior osteotomies, whereas 12 had anterior and posterior osteotomies in staged or sequential (same day) fashion. Diagnosis was idiopathic scoliosis for the index operation. At revision, the primary deformity was flatback deformity in 10 patients and pseudarthrosis with progressive deformity in 17 patients. Eleven patients had predominant sagittal decompensation, 11 patients had multiplanar decompensation, and five patients were balanced. The average number of osteotomies performed anteriorly was 4.3 levels (range, 1-8) and the average number of osteotomies posteriorly was 4.6 levels (range, 1-10). There were a total of nine complications in eight patients including three pseudarthroses (11%), five hardware failures (19%), and one transient neurologic deficit (4%). There were no deep wound infections, deep vein thromboses, pulmonary emboli, or deaths. The average scoliosis correction was 40% (range, 5-81%), whereas the average sagittal balance was corrected 6.5 cm (range, -5-29.5 cm), on average, and coronal balance was corrected 2.5 cm (range, 1-6 cm), on average.
This study demonstrates multiple vertebral osteotomies (anterior and/or posterior) in the management of rigid adult spine deformities and deformity correction with an acceptable complication rate. Use of vertebral osteotomies for patients undergoing revision spine surgery is a safe and reasonable approach to obtain an arthrodesis.
对采用截骨技术实现脊柱平衡和矫正脊柱畸形的成人翻修脊柱畸形手术的临床及影像学结果进行回顾性研究。
评估多节段椎体截骨术对接受翻修手术的成年患者僵硬脊柱畸形的矫正效果。
回顾性分析27例特发性脊柱侧凸成年患者的病历及X线片，这些患者接受了需要前路松解（椎间盘切除术和/或截骨术）及后路截骨术以矫正僵硬脊柱畸形的翻修手术。
所有27例患者均接受了随访评估。15例患者先行前路椎间盘切除术，随后行后路截骨术；12例患者分期或同期（同一天）进行了前路和后路截骨术。初次手术诊断为特发性脊柱侧凸。翻修时，主要畸形为10例平背畸形和17例假关节伴进行性畸形。11例患者主要存在矢状面失代偿，11例患者存在多平面失代偿，5例患者脊柱平衡。前路平均截骨节段数为4.3个节段（范围1 - 8个节段），后路平均截骨节段数为4.6个节段（范围1 - 10个节段）。8例患者共发生9例并发症，包括3例假关节形成（11%）、5例内固定失败（19%）和1例短暂性神经功能缺损（4%）。未发生深部伤口感染、深静脉血栓形成、肺栓塞或死亡。平均脊柱侧凸矫正率为40%（范围5% - 81%），矢状面平均平衡矫正6.5 cm（范围 - 5 - 29.5 cm），冠状面平均平衡矫正2.5 cm（范围1 - 6 cm）。
本研究表明多节段椎体截骨术（前路和/或后路）可用于治疗成年僵硬脊柱畸形，且畸形矫正效果良好，并发症发生率可接受。对接受翻修脊柱手术的患者采用椎体截骨术是获得脊柱融合的一种安全且合理的方法。
