椎弓根截骨术（PSO）与闭合-开放楔形截骨术（鱼嘴PSO）治疗矢状面畸形矫正的对比研究
Comparative Study Between Pedicle Subtraction Osteotomy (PSO) and Closing-Opening Wedge Osteotomy (Fish-Mouth PSO) for Sagittal Plane Deformity Correction.
作者信息
Park Jong-Hwa, Hyun Seung-Jae, Kim Ki-Jeong, Jahng Tae-Ahn
机构信息
Department of Neurosurgery, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, Republic of Korea.
Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
出版信息
Spine (Phila Pa 1976). 2017 Aug 1;42(15):E899-E905. doi: 10.1097/BRS.0000000000002007.
STUDY DESIGN
A retrospective study.
OBJECTIVE
To evaluate the safety and efficacy of closing-opening wedge osteotomy (fish-mouth pedicle subtraction osteotomy [PSO]), for sagittal plane deformity correction and to compare the radiographical outcomes for patients undergoing conventional- and fish-mouth PSO.
SUMMARY OF BACKGROUND DATA
The closing-opening wedge osteotomy has been developed to achieve a large magnitude of correction at a single level for patients with severe fixed sagittal imbalance.
METHODS
We retrospectively reviewed the medical records and the radiographs of patients who underwent PSO by a single surgeon between June 2012 and December 2015. Forty patients were included and were divided into 2 groups according to surgical technique (fish-mouth- vs. conventional PSO group). Radiographical measurements included pelvic incidence, thoracic kyphosis, lumbar lordosis, global kyphosis (GK), sagittal vertical axis, osteotomized vertebra angle (OVA), and the height of the osteotomized vertebra (HOV).
RESULTS
The preoperative, immediate postoperative, ultimate follow-up and correction of thoracic kyphosis, lumbar lordosis, thoracolumbar junction, and sagittal vertical axis did not show significant differences between the groups. Preoperative GK and OVA were significantly larger in fish-mouth group (GK: 47.1° ± 28.8° vs. 23.7° ± 16.0°, P < 0.05 and OVA: 31.7° ± 14.5° vs. 9.0° ± 11.4°, P < 0.05). The correction of GK and OVA were significantly larger in fish-mouth PSO group (GK: 48.8° ± 24.5° vs. 34.8° ± 17.4°, P < 0.05 and OVA: 42.9° vs. 25.0°, P < 0.05). Preoperative HOV between the groups was not significantly different; however, postoperative HOV was significantly greater in fish-mouth PSO group (2.3 vs. 1.7 cm, P < 0.05). Postoperative transient paraparesis occurred in 3 (20%) and 6 (24%) patients of fish-mouth PSO and PSO group, respectively.
CONCLUSION
Fish-mouth PSO can provide a larger magnitude of correction compared to classic PSO without compromising spinal cord function for fixed sagittal plane deformity.
LEVEL OF EVIDENCE
研究设计
一项回顾性研究。
目的
评估闭合-开放楔形截骨术（鱼嘴椎弓根减法截骨术[PSO]）在矢状面畸形矫正中的安全性和有效性，并比较接受传统PSO和鱼嘴PSO患者的影像学结果。
背景资料总结
闭合-开放楔形截骨术已被研发出来，用于为严重固定矢状面失衡的患者在单一节段实现大幅度矫正。
方法
我们回顾性分析了2012年6月至2015年12月间由同一位外科医生实施PSO手术的患者的病历和X线片。纳入40例患者，根据手术技术分为2组（鱼嘴PSO组和传统PSO组）。影像学测量包括骨盆入射角、胸椎后凸、腰椎前凸、整体后凸（GK）、矢状垂直轴、截骨椎角度（OVA）和截骨椎高度（HOV）。
结果
两组患者术前、术后即刻、最终随访时以及胸椎后凸、腰椎前凸、胸腰段交界处和矢状垂直轴的矫正情况均无显著差异。鱼嘴组术前GK和OVA显著更大（GK：47.1°±28.8°对23.7°±16.0°，P<0.05；OVA：31.7°±14.5°对9.0°±11.4°，P<0.05）。鱼嘴PSO组GK和OVA的矫正幅度显著更大（GK：48.8°±24.5°对34.8°±17.4°，P<0.05；OVA：42.9°对25.0°，P<0.05）。两组术前HOV无显著差异；然而，鱼嘴PSO组术后HOV显著更大（2.3对1.7cm，P<0.05）。鱼嘴PSO组和PSO组分别有3例（20%）和6例（24%）患者术后出现短暂性下肢轻瘫。
结论
对于固定矢状面畸形，与经典PSO相比，鱼嘴PSO能提供更大幅度的矫正，且不影响脊髓功能。
证据级别
3级。
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