Yang Jae Hyuk, Suh Seung Woo, Cho Won Tae, Hwang Jin Ho, Hong Jae Young, Modi Hitesh N
*Department of Orthopedics, Scoliosis Research Institute, Korea University Medical College, Guro Hospital, Seoul, Korea †Orthopaedic Surgery, Yonsei University College of Medicine, Division of Paediatric Orthopaedics, Severance Children's Hospital, Sinchon-dong, Seodaemun-gu, Seoul, Korea; and ‡Department of Orthopedics, Korea University Medical College, Ansan Hospital, Danwon-gu, Ansan-si, Gyeonggi-do, Korea.
Spine (Phila Pa 1976). 2014 Oct 15;39(22):1840-9. doi: 10.1097/BRS.0000000000000555.
Prospective case series study.
To study the effect of posterior multilevel vertebral osteotomy (posterior crack osteotomy) on coronal and sagittal balance in patients with the fusion mass over the spine caused by previous surgery.
Few studies have investigated revisional scoliosis surgery with the fusion mass using osteotomy.
Among patients who had a history of prior surgery for scoliosis correction and posterior fusion, those showing progression of the curve postoperatively due to nonunion, implant failure, or adding-on phenomenon were enrolled. All patients were treated using posterior crack osteotomy. For clinical evaluation, the pre- and postoperative Gross Motor Function Classification System score for walking status and the Berg balanced scale were used. For radiological evaluation, pre- and postoperative Cobb angle, and coronal and sagittal balance factors were used.
Ten patients (5 males and 5 females) were enrolled. The preoperative diagnosis was neuromuscular scoliosis (3 cases), syndromic scoliosis (1 case), congenital scoliosis (5 cases), and neurofibromatosis (1 case). Osteotomies were performed at 3.3±1.3 levels on average. Pre- and postoperative Cobb angles were 70.8°±30.0° and 28.1°±20.0° (P=0.002 (0.97)), respectively. In pre- and postoperative evaluation of coronal balance, the coronal balance, clavicle angle, and T1-tilt angle were 36.8±27.1 mm and 10.4±8.5 mm, 6.7°±8.0° and 3.3°±1.5°, and 7.8°±19.0° and 4.7°±2.1°, respectively (P=0.002, 0.002, 0.002). In pre- and postoperative evaluation of sagittal balance, the spinal vertical axis, thoracic kyphosis, and lumbar alignments were 25.1±37.8 mm and 14.1±21.8 mm, 33.5°±51.1° and 29.7°±27.4°, and 45.7°±34.8° and 48.9°±23.1° (P=0.002, 0.169, 0.169). The walking and functional statuses did not change (P=0.317, 0.932). Although pulmonary and gastrointestinal complications were noted, the patients were discharged without complications.
Posterior crack osteotomy can be used effectively in revisional scoliosis surgery and the clinical and radiological results seem to be acceptable.
前瞻性病例系列研究。
探讨后路多级椎体截骨术（后路劈裂截骨术）对既往手术导致脊柱融合块患者冠状面和矢状面平衡的影响。
很少有研究使用截骨术对伴有融合块的翻修性脊柱侧弯手术进行研究。
纳入有脊柱侧弯矫正和后路融合既往手术史、术后因骨不连、内固定失败或附加现象导致侧弯进展的患者。所有患者均采用后路劈裂截骨术治疗。临床评估采用术前和术后行走状态的粗大运动功能分级系统评分及伯格平衡量表。影像学评估采用术前和术后的Cobb角、冠状面和矢状面平衡因子。
共纳入10例患者（男5例，女5例）。术前诊断为神经肌肉型脊柱侧弯（3例）、综合征型脊柱侧弯（1例）、先天性脊柱侧弯（5例）和神经纤维瘤病（1例）。平均截骨3.3±1.3个节段。术前和术后Cobb角分别为70.8°±30.0°和28.1°±20.0°（P = 0.002（0.97））。在冠状面平衡的术前和术后评估中，冠状面平衡、锁骨角和T1倾斜角分别为36.8±27.1mm和10.4±8.5mm、6.7°±8.0°和3.3°±1.5°、7.8°±19.0°和4.7°±2.1°（P = 0.002、0.002、0.002）。在矢状面平衡的术前和术后评估中，脊柱垂直轴、胸椎后凸和腰椎排列分别为25.1±37.8mm和14.1±21.8mm、33.5°±51.1°和29.7°±27.4°、45.7°±34.8°和48.9°±23.1°（P = 0.002、0.169、0.169）。行走和功能状态未改变（P = 0.317、0.932）。虽然注意到有肺部和胃肠道并发症，但患者均无并发症出院。
后路劈裂截骨术可有效用于翻修性脊柱侧弯手术，临床和影像学结果似乎可以接受。
4级。
