Zeng Yan, Qu Xiaochen, Chen Zhongqiang, Yang Xiaoxi, Guo Zhaoqing, Qi Qiang, Li Weishi, Sun Chuiguo
Orthopedic Department, Peking University Third Hospital, No 49. North Garden St, Haidian District, Beijing, 100191, China.
Eur Spine J. 2017 Jul;26(7):1833-1841. doi: 10.1007/s00586-016-4875-8. Epub 2016 Dec 28.
To evaluate the radiological and clinical outcomes of the corrective surgery for patients with moderate to severe focal kyphosis in thoracolumbar spine.
Fifty-seven patients with moderate to severe focal kyphosis of the thoracolumbar spine underwent apical segmental resection osteotomy with dual axial rotation correction at our hospital. There were 30 male and 27 female patients. The mean age was 34.3 years. The kyphosis level radiographs were obtained from each patient before surgery, immediately after surgery and at follow-up. Local kyphosis and scoliosis Cobb angles were measured. Full-spine standing radiographs were obtained before surgery and at follow-up, and the spine sagittal and coronal balance were evaluated. The height of patients, the Frankel grading system for neurological functions, the Oswestry disability index for life quality, the visual analogue score for back pain and the patient satisfactory index for satisfaction to surgery were applied before surgery and at follow-up. The radiological and clinical outcomes were further analyzed in different sub-groups of patients according to etiology, severity of kyphosis, age, level of kyphosis apex, Frankel grade before surgery, and complications.
The average follow-up time of patients was 46.1 months. The average kyphosis angle reduced from 94.6° before surgery to 31.0° immediately after surgery, and remained at 34.4° at follow-up. The sagittal balance of the spine, height of patients, Frankel grading, Oswestry disability index and visual analogue score were improved. The patient satisfactory index (PSI) showed a satisfied rate of 91.2%. The correction rate was significantly higher in patients with kyphosis angle less than 95° and age less than 35 years. The clinical improvement rate was significantly higher in patient with kyphosis apex at lower thoracic spine or thoracolumbar segment, Frankel grade E before surgery and no complication group. The incidence of intra-operative and early stage complications was 38.6%, and the incidence of instrumentation failure was 10.5%. The most severe complication was transient spinal cord injury, and the incidence was 7.0%. All complications got good relief after appropriate intervention.
Apical segmental resection osteotomy with dual axial rotation correction is an effective procedure to treat moderate to severe focal kyphosis, the prevention of serious neurological complications is fundamental to achieve the ideal clinical results.
评估胸腰椎中重度局灶性后凸畸形患者矫正手术的影像学和临床疗效。
57例胸腰椎中重度局灶性后凸畸形患者在我院接受了顶椎节段切除截骨术并进行双轴旋转矫正。其中男性30例，女性27例。平均年龄34.3岁。在术前、术后即刻及随访时获取每位患者的后凸畸形节段X线片，测量局部后凸和脊柱侧凸的Cobb角。在术前及随访时获取全脊柱站立位X线片，评估脊柱矢状面和冠状面平衡。在术前及随访时应用患者身高、神经功能Frankel分级系统、生活质量Oswestry功能障碍指数、背痛视觉模拟评分以及患者对手术的满意度指标。根据病因、后凸畸形严重程度、年龄、后凸畸形顶点水平、术前Frankel分级及并发症情况，对不同亚组患者的影像学和临床疗效进行进一步分析。
患者平均随访时间为46.1个月。平均后凸角从术前的94.6°降至术后即刻的31.0°，随访时为34.4°。脊柱矢状面平衡、患者身高、Frankel分级、Oswestry功能障碍指数及视觉模拟评分均得到改善。患者满意度指标显示满意率为91.2%。后凸角小于95°且年龄小于35岁的患者矫正率显著更高。后凸顶点位于下胸椎或胸腰段、术前Frankel分级为E级且无并发症组的患者临床改善率显著更高。术中及早期并发症发生率为38.6%，内固定失败发生率为10.5%。最严重的并发症是短暂性脊髓损伤，发生率为7.0%。所有并发症经适当干预后均得到良好缓解。
顶椎节段切除截骨术并进行双轴旋转矫正是治疗中重度局灶性后凸畸形有效的手术方法，预防严重神经并发症是取得理想临床疗效的根本。
