一期脊柱截骨术治疗合并脊髓纵裂畸形的重度僵硬型先天性脊柱侧凸的安全性和有效性
Safety and Efficacy of One-stage Spinal Osteotomy for Severe and Rigid Congenital Scoliosis Associated with Split Spinal Cord Malformation.
作者信息
Chen Bo, Yuan Zhi, Chang Michael S, Huang Jing-Hui, Li Huan, Yang Wei-Zhou, Luo Zhuo-Jing, Tao Hui-Ren
机构信息
*Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China †Sonoran Spine Center, Mesa, AZ; and ‡Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
出版信息
Spine (Phila Pa 1976). 2015 Sep 15;40(18):E1005-13. doi: 10.1097/BRS.0000000000001039.
STUDY DESIGN
Retrospective clinical study.
OBJECTIVE
To retrospectively evaluate the safety and efficacy of one-stage spinal osteotomy in the treatment of severe and progressive congenital scoliosis (CS) associated with split spinal cord malformation (SSCM).
SUMMARY OF BACKGROUND DATA
For severe and rigid spinal deformity, spinal osteotomies are often advocated for correcting the deformity. However, the safety and efficacy of one-stage spinal osteotomy in the treatment of severe and rigid CS with SSCM have been unclear thus far.
METHODS
Patients were treated by one-stage spinal osteotomy between September 2007 and June 2011 in our hospital. The clinical records were reviewed for demographic and radiographical data, operative time, intraoperative blood loss, blood transfusion, perioperative complications, and functional outcomes.
RESULTS
There were 18 females and 11 males with an average age of 15.5 ± 3.6 years (range, 12-28 yr). Spinal cord was longitudinally split by a bony spur in 11 patients (type I SSCM) and by a fibrous band in 18 patients (type II SSCM). Patients were observed for a minimum of 24 months after initial surgical treatment with an average follow-up of 43.0 ± 17.1 months (range 24-68 mo) from September 2007 to June 2013. The mean operative time and average blood loss of type ISSCM was significantly greater than those of type II SSCM (P < 0.05). The major curve was corrected from an average of 97.2°± 17.8° to 35.7°± 15.9°, a mean correction rate of 64.3% ± 11.0%. The average loss of correction at final follow-up was 2.9% for major curves. The overall complication rate was 24.1%, including transient neurological deterioration in 3 patients, cerebrospinal fluid leakage in 2 patients, urinary tract infection in 1 patient and pleural rupture in 1 patient.
CONCLUSION
Relative to multistage corrective surgery, one-stage spinal osteotomy is effective for the correction of severe CS and SSCM without increasing the rate of surgical complications. However, surgical treatment of type I SSCM does require more operating time and blood loss.
LEVEL OF EVIDENCE
研究设计
回顾性临床研究。
目的
回顾性评估一期脊柱截骨术治疗伴有脊髓纵裂畸形（SSCM）的严重进展性先天性脊柱侧凸（CS）的安全性和有效性。
背景资料总结
对于严重僵硬的脊柱畸形，常主张采用脊柱截骨术来矫正畸形。然而，迄今为止，一期脊柱截骨术治疗伴有SSCM的严重僵硬型CS的安全性和有效性尚不清楚。
方法
2007年9月至2011年6月期间，我院对患者采用一期脊柱截骨术进行治疗。回顾临床记录，收集人口统计学和影像学数据、手术时间、术中失血量、输血情况、围手术期并发症及功能结果。
结果
共纳入18例女性和11例男性患者，平均年龄15.5±3.6岁（范围12 - 28岁）。11例患者脊髓被骨嵴纵向劈开（I型SSCM），18例患者脊髓被纤维带纵向劈开（II型SSCM）。初次手术治疗后对患者进行至少24个月的观察，从2007年9月至2013年6月平均随访43.0±17.1个月（范围24 - 68个月）。I型SSCM的平均手术时间和平均失血量显著高于II型SSCM（P < 0.05）。主弯平均从97.2°±17.8°矫正至35.7°±15.9°，平均矫正率为64.3%±11.0%。末次随访时主弯平均矫正丢失率为2.9%。总体并发症发生率为24.1%，包括3例患者出现短暂性神经功能恶化、2例患者出现脑脊液漏、1例患者出现尿路感染、1例患者出现胸膜破裂。
结论
相对于多阶段矫正手术，一期脊柱截骨术在矫正严重CS和SSCM方面有效，且不增加手术并发症发生率。然而，I型SSCM的手术治疗确实需要更多的手术时间和失血量。
证据级别
4级。
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