Yang Yang, Liu Bin, Rong Limin, Chen Ruiqiang, Dong Jianwen, Xie Peigen, Zhang Liangming, Yang Bu, Shu Tao, Pang Mao
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Jan;30(1):72-6.
To evaluate the effectiveness of modified "eggshell" osteotomy for the treatment of thoracolumbar kyphoscoliosis. METHODS Between April 2009 and June 2014, 19 patients with spinal deformity underwent modified "eggshell" osteotomy consisting of preserving posterior bony structures initially and enlarging surgical field for cancellous bone removal. There were 14 males and 5 females with an average age of 37.8 years (range, 18-76 years) and with a median disease duration of 7 years (range, 1-40 years). The disease causes included ankylosing spondylitis in 13 cases, spinal tuberculosis in 3 cases, and chronic vertebral compression fracture in 3 cases. Eleven patients showed single kyphosis and 8 patients had kyphoscoliosis. Preoperative Cobb angle of kyphosis was (64.2 ±30.1)degrees, while Cobb angle of scoliosis was (19.9 ± 12.8)degrees. Apical vertebraes were T10 in 1 case, L1 in 3 cases, L2 in 7 cases, T10, 11 in 2 cases, T12, L1 in 4 cases, T12-L2 in 1 case, and T10-L1 in 1 case. Preoperative visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were 6.1 ± 1.9 and 15.2 ± 5.6, respectively. According to Frankel criteria for spinal cord function, 16 cases were rated as grade E and 3 cases as grade D before operation. Cobb angle, VAS, and JOA scors were used to assess relief of symptom.
The operation time was 215-610 minutes (mean, 343 minutes); intraoperative blood loss ranged from 900 to 3 000 mL (mean, 1 573 mL). All incisions healed primarily. Delayed onset ischemia-reperfusion injury of spinal cord occurred in 1 case at 6 days after operation, and symptoms alleviated after conservative treatments. All 19 cases were followed up 14-76 months (mean, 46 months). No loosening or breakage of internal fixation was observed during follow-up. Cobb angle of kyphosis, Cobb angle of scoliosis, VAS and JOA scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative ones (P < 0.05). VAS and JOA scores at last follow-up were significantly improved when compared with scores at 1 week after operation (P < 0.05), but no significant difference was found in Cobb angle of both kyphosis and scoliosis between at 1 week after operation and at last follow-up (P > 0.05). At 1 week after operation, the correction rate for kyphosis was 34.1%-93.4% (mean, 62.2%), and the correction rate for scoliosis was 42.4%-100% (mean, 68.9%). At 48 months after operation, 3 patients with preoperative impaired spinal cord function achieved full recovery.
Modified "eggshell" osteotomy owns the advantages of shorter operation time and less intraoperative blood loss, thus it is able to correct thoracolumbar kyphoscoliosis safely and effectively.
评估改良“蛋壳”截骨术治疗胸腰椎后凸畸形的有效性。方法 2009年4月至2014年6月，19例脊柱畸形患者接受改良“蛋壳”截骨术，该术式先保留后方骨质结构并扩大手术视野以去除松质骨。其中男性14例，女性5例，平均年龄37.8岁（范围18 - 76岁），疾病中位病程7年（范围1 - 40年）。病因包括强直性脊柱炎13例、脊柱结核3例、慢性椎体压缩骨折3例。11例表现为单纯后凸，8例为后凸畸形。术前后凸Cobb角为(64.2 ±30.1)°，侧凸Cobb角为(19.9 ± 12.8)°。顶椎：T10 1例、L1 3例、L2 7例、T10、11 2例、T12、L1 4例、T12 - L2 1例、T10 - L1 1例。术前视觉模拟评分（VAS）和日本骨科学会（JOA）评分分别为6.1 ± 1.9和15.2 ± 5.6。根据Frankel脊髓功能分级标准，术前16例为E级，3例为D级。采用Cobb角、VAS和JOA评分评估症状缓解情况。
手术时间215 - 610分钟（平均343分钟）；术中出血量900 - 3000 mL（平均1573 mL）。所有切口均一期愈合。1例术后6天发生迟发性脊髓缺血再灌注损伤，经保守治疗后症状缓解。19例均获随访14 - 76个月（平均46个月）。随访期间未观察到内固定松动或断裂。术后1周及末次随访时后凸Cobb角、侧凸Cobb角、VAS和JOA评分与术前相比均显著改善（P < 0.05）。末次随访时VAS和JOA评分与术后1周相比显著改善（P < 0.05），但术后1周与末次随访时后凸和侧凸Cobb角比较差异无统计学意义（P > 0.05）。术后1周，后凸矫正率为34.1% - 93.4%（平均62.2%），侧凸矫正率为42.4% - 100%（平均68.9%）。术后48个月，3例术前脊髓功能受损患者完全恢复。
改良“蛋壳”截骨术具有手术时间短、术中出血少的优点，能安全有效地矫正胸腰椎后凸畸形。
