Zhang Guoying, Zhang Yonggang, Zhang Xuesong, Wang Zheng, Mao Keya, Wang Yan
Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Oct;26(10):1197-201.
To investigate the effectiveness of multilevel Ponte osteotomies on maintenance and restoration of thoracic kyphosis in idiopathic scoliosis (IS) surgery.
Between March 2008 and February 2010, 42 patients with thoracic IS (Lenke type 1 curves) were corrected with posterior pedicle screw system. Multilevel Ponte osteostomies for posterior release was performed in 17 cases (group A), and the 3 segments near the apical vertebrae were selected as the osteotomy site; simple posterior soft tissue release was given in 25 cases (group B). There was no significant difference in sex, age, disease duration, lesion segments, coronary Cobb angle, thoracic kyphosis, Risser index, and bending flexibility between 2 groups (P > 0.05). The anteroposterior and lateral standing radiographs of the spine were taken to compare the effectiveness between 2 groups.
Operation was successfully completed in all patients. The operation time and blood loss in group A were significantly greater than those in group B (P < 0.05). Spine dural injury and leakage of cerebrospinal fluid occurred in 1 case of group A, which was cured after compression on local area of the wound; the other patients had no intraoperative complications. The patients were followed up 2-4 years (mean, 2.8 years); no nerve injury, infection, or internal fixation failure occurred. No obvious correction loss was observed and the appearance and trunk balance were significantly improved. The coronal Cobb angles at 1 week and 2 years after operation were significantly improved when compared with preoperative ones in 2 groups (P < 0.05). There was no significant difference in the coronal Cobb angle and correction rate between 2 groups at 1 week and 2 years after operation (P > 0.05). Group A was significantly better than group B in the thoracic kyphotic angle and angle changes at 1 week and 2 years after operation (P < 0.05).
The posterior approach surgery with multilevel Ponte osteotomies can restore the thoracic kyphosis in IS, but it has no effect on coronal correction in Lenke type 1 curves.
探讨多级 Ponte 截骨术在特发性脊柱侧凸（IS）手术中维持及恢复胸椎后凸的有效性。
2008 年 3 月至 2010 年 2 月，42 例胸椎 IS（Lenke 1 型曲线）患者采用后路椎弓根螺钉系统进行矫正。17 例患者（A 组）行多级 Ponte 截骨术进行后路松解，选择顶椎附近 3 个节段作为截骨部位；25 例患者（B 组）仅行单纯后路软组织松解。两组患者在性别、年龄、病程、病变节段、冠状面 Cobb 角、胸椎后凸、Risser 指数及弯曲柔韧性方面差异均无统计学意义（P > 0.05）。拍摄脊柱站立位正侧位 X 线片比较两组疗效。
所有患者手术均顺利完成。A 组手术时间及出血量均显著多于 B 组（P < 0.05）。A 组 1 例发生脊柱硬膜损伤及脑脊液漏，经伤口局部压迫后治愈；其余患者术中无并发症发生。患者随访 2～4 年（平均 2.8 年）；未发生神经损伤、感染或内固定失败。未观察到明显的矫正丢失，外观及躯干平衡明显改善。两组术后 1 周及 2 年冠状面 Cobb 角较术前均显著改善（P < 0.05）。术后 1 周及 2 年两组冠状面 Cobb 角及矫正率差异无统计学意义（P > 0.05）。术后 1 周及 2 年 A 组胸椎后凸角及角度变化均显著优于 B 组（P < 0.05）。
后路多级 Ponte 截骨术可恢复 IS 患者的胸椎后凸，但对 Lenke 1 型曲线的冠状面矫正无效。
