Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
J Neurosurg Spine. 2015 Jul;23(1):42-8. doi: 10.3171/2014.11.SPINE14710. Epub 2015 Apr 24.
The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis.
A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle > 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3-5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°-75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle > 60°) were used as a control group (Group B).
In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°-24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200-8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°-34°), and there was no significant loss of correction (p > 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p < 0.05).
An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis resulted in significant reduction of the kyphotic angle, few complications, and good follow-up results. However, a larger series of patients and long-term follow-up results is still required to verify the effectiveness and safety of this method.
本研究旨在确定改良脊柱切除术治疗胸腰椎角状后凸的疗效。
本研究共纳入 13 例胸腰椎后凸（后凸角＞60°）患者（A 组）。其中 3 例为脊柱融合失败（1 型畸形），6 例为陈旧性胸腰椎压缩骨折，4 例为陈旧性脊柱结核（包括 1 例 T3-5 椎体畸形愈合）。术前平均后凸角为 67.3°（62°-75°）。每位患者均采用扩大蛋壳法结合闭合-开放技术治疗胸腰椎角状后凸。同期同脊柱分类组（后凸角＞60°）采用闭合-开放楔形截骨术治疗的 16 例患者作为对照组（B 组）。
A 组手术时间平均（±SD）为 400±60min，出血量平均为 960±120ml。术中及术后均无手术相关并发症发生。局部后凸角平均为 20.3°（18°-24.5°），矫正率平均为 68.7%。B 组手术时间平均为 470±90min，出血量平均为 2600±1600ml（1200-8200ml）。1 例发生节段血管和椎管静脉丛损伤，1 例发生脊髓损伤，2 例发生硬脊膜撕裂，2 例发生气胸，1 例发生血气胸。每组患者均随访 2 年以上。末次随访时，局部后凸角平均为 19.9°±9.1°（19°-34°），无明显矫正丢失（p＞0.05）。B 组出血量多于 A 组，并发症发生率高于 A 组（p＜0.05）。
扩大蛋壳法结合闭合-开放技术治疗胸腰椎角状后凸可显著降低后凸角，并发症少，随访效果好。但仍需要更大样本量的患者和长期随访结果来验证该方法的有效性和安全性。
