Hao Chou-kuan, Li Wei-shi, Chen Zhong-qiang
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Chin Med J (Engl). 2008 Oct 5;121(19):1906-10.
This study investigated the relationship between the height of osteotomy and the correction of the kyphotic angle during posterior closing wedge osteotomy with instrumentation and the spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach in thoracolumbar kyphosis, and using this relationship as the basis of the preoperative design.
From April 1996 to June 2007, 30 thoracolumbar kyphosis patients with complete medical records and clear X-ray photograms have undergone operation. Of these 30 cases, 16 cases underwent posterior closing wedge osteotomy with instrumentation while the height of the osteotomy and the correction of the angle have been measured; 14 cases underwent spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach while the height of the osteotomy, the height and the place of the cage and the correction of the angle were also measured. A simple geometrical model was simulated to calculate the relationship between the height of the osteotomy and the correction of the angle and these results are finally compared with the data coming from the actual measuring by the Wilcoxon statistic method.
The distribution of data from the 16 cases by posterior closing wedge osteotomy with instrumentation was as such: 9 male and 7 female, the mean age was 49.2 years (range 38-70), the kyphosis improved from an average of 30 degrees (range 15 degrees-45 degrees) preoperatively to 4 degrees (range -26 degrees-30 degrees) postoperatively, the kyphosis was corrected on average 2.5 degrees per 1 mm in the height of the osteotomy. The results from the simple geometrical model were that the mean of the correction of the angle per 1 mm was 2.2 degrees. As a result, there was no significant difference (P > 0.05) when comparing the measurement collected with the result simulated from the geometric model. The distribution of data from the 14 cases by spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach was as such: 5 male and 9 female, the mean age was 35.3 years old (range 15 - 57), the kyphosis improved from an average of 64 degrees (range 34 degrees-95 degrees) preoperatively to 8.7 degrees (range -10 degrees-22 degrees) postoperatively. The kyphosis was corrected on average of 6.2 degrees per 1 mm in the height of the osteotomy. The results from the simple geometrical model is that the mean of the correction of the angle per 1 mm was 6.6 degrees . There was also no significant difference (P > 0.05) when comparing the measurement collected with the result simulated from the geometric model.
The therapeutic effect is significant for both posterior closing wedge osteotomy with instrumentation and spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach. The posterior closing wedge osteotomy with instrumentation is an easier approach with the mean angle of the correction per 1 mm of 2.5 degrees and the maximum angle of correction of 45 degrees . The spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach is more efficient with the mean angle of correction per 1 mm of 6.2 degrees . It should be reserved for the severe cases of thoracolumbar kyphosis. We can also use the formula to help us constructing preoperative design.
本研究探讨了在胸腰椎后凸畸形患者中，采用器械辅助的后路闭合楔形截骨术以及椎间植骨融合单一切口后路闭合截骨术时，截骨高度与后凸角矫正之间的关系，并将此关系作为术前设计的依据。
1996年4月至2007年6月，30例胸腰椎后凸畸形患者，病历资料完整，X线片清晰，均接受手术治疗。其中16例行器械辅助的后路闭合楔形截骨术，测量截骨高度及角度矫正情况；14例行椎间植骨融合单一切口后路闭合截骨术，测量截骨高度、椎间融合器高度及位置以及角度矫正情况。模拟一个简单的几何模型计算截骨高度与角度矫正之间的关系，最后采用Wilcoxon统计方法将这些结果与实际测量数据进行比较。
16例行器械辅助的后路闭合楔形截骨术患者的数据分布如下：男性9例，女性7例，平均年龄49.2岁（38 - 70岁），后凸畸形术前平均30°（15° - 45°），术后平均4°（-26° - 30°），截骨高度每增加1mm，后凸角平均矫正2.5°。简单几何模型计算结果为每1mm角度矫正平均值为2.2°。因此，实际测量结果与几何模型模拟结果比较，差异无统计学意义（P > 0.05）。14例行椎间植骨融合单一切口后路闭合截骨术患者的数据分布如下：男性5例，女性9例，平均年龄35.3岁（15 - 57岁），后凸畸形术前平均64°（34° - 95°），术后平均8.7°（-10° - 22°）。截骨高度每增加1mm，后凸角平均矫正6.2°。简单几何模型计算结果为每1mm角度矫正平均值为6.6°。实际测量结果与几何模型模拟结果比较，差异无统计学意义（P > 0.05）。
器械辅助的后路闭合楔形截骨术以及椎间植骨融合单一切口后路闭合截骨术治疗胸腰椎后凸畸形疗效显著。器械辅助的后路闭合楔形截骨术操作相对简单，截骨高度每1mm平均矫正角度为2.5°，最大矫正角度为45°。椎间植骨融合单一切口后路闭合截骨术效率更高，截骨高度每1mm平均矫正角度为6.2°。该术式适用于胸腰椎后凸畸形严重的病例。我们也可使用该公式辅助进行术前设计。
