Department of Orthopaedic Surgery, Cankaya Hospital, Ankara, Turkey.
Department of Anesthesiology, Cankaya Hospital, Ankara, Turkey.
Spine (Phila Pa 1976). 2018 Aug 1;43(15):E905-E910. doi: 10.1097/BRS.0000000000002538.
Retrospective analysis.
The aim of this study is to compare the safety and efficacy of the apical pedicle subtraction osteotomy (PSO) technique with multiple posterior column osteotomies (PCOs) in nonambulatory patients with severe, rigid neuromuscular scoliosis.
Neuromuscular scoliosis frequently causes intolerance to sitting due to pelvic obliquity, trunk decompensation, and associated back and rib impingement pain which diminish the patient's functional capacity. In the case of rigid curves, spinal osteotomy techniques are occasionally required for effective correction.
We retrospectively reviewed our patients with severe and rigid neuromuscular scoliosis with associated pelvic obliquity who were treated with posterior instrumented fusion extending to pelvis with more than 1-year postoperative follow-up. We compared radiological and clinical results of PSO and multiple PCO techniques in severe rigid neuromuscular scoliosis with pelvic obliquity of more than 15° in traction radiograph under general anesthesia. Hospital records were also reviewed for operative time, intraoperative blood loss, amount of blood transfusion, duration of hospital stay, and complications.
There were 12 patients in the PSO group and 10 patients in the PCO group. There was no significant difference between groups in terms of major curve magnitude, sagittal parameters or pelvic obliquity. Although not statistically significant, PSO technique did trend toward better scoliosis correction (post-op Cobb angle 56.1° vs. 66.7° [P = 0.415]). PSO technique provided a significantly better correction in pelvic obliquity (59% vs. 84%) (P = 0.001). There was no significant difference in average intraoperative blood loss, transfusion, and operative times including anesthesia time, hospital stay, or complications.
PSO may be an option in correction of severe and rigid neuromuscular scoliosis. It provides better correction of pelvic obliquity without increasing operative time, need for transfusion, or duration of hospitalization as compared to multiple apical PCO technique. Traction radiograph under general anesthesia is a valuable tool in surgical decision making.
回顾性分析。
本研究旨在比较经顶椎椎弓根切除截骨术（PSO）与多节段后路全脊椎截骨术（PCO）治疗非卧床严重僵硬型神经肌肉型脊柱侧凸患者的安全性和疗效。
神经肌肉型脊柱侧凸常因骨盆倾斜、躯干代偿性失稳以及由此引起的背部和肋骨撞击痛导致患者不耐久坐，从而降低其功能能力。对于僵硬型脊柱侧凸，有时需要脊柱截骨术进行有效矫正。
我们回顾性分析了 12 例在全身麻醉下牵引位 X 线片上骨盆倾斜＞15°的严重僵硬型神经肌肉型脊柱侧凸患者，这些患者接受了后路带骨盆固定的节段性脊柱融合术，术后随访超过 1 年。我们比较了 PSO 和多节段 PCO 技术在严重僵硬型神经肌肉型脊柱侧凸合并骨盆倾斜＞15°患者中的影像学和临床结果。同时还查阅了手术时间、术中失血量、输血量、住院时间和并发症等病历记录。
PSO 组 12 例，PCO 组 10 例。两组患者的主弯角度、矢状位参数或骨盆倾斜程度无显著差异。尽管差异无统计学意义，但 PSO 技术确实显示出更好的脊柱侧凸矫正（术后 Cobb 角 56.1° vs. 66.7°[P=0.415]）。PSO 技术在骨盆倾斜矫正方面有显著优势（59% vs. 84%）（P=0.001）。两组患者的平均术中失血量、输血量、手术时间（包括麻醉时间）、住院时间或并发症无显著差异。
PSO 可能是治疗严重僵硬型神经肌肉型脊柱侧凸的一种选择。与多节段 PCO 技术相比，PSO 可在不增加手术时间、输血需求和住院时间的情况下，更好地矫正骨盆倾斜。全身麻醉下的牵引位 X 线片是手术决策的一种有价值的工具。
4 级
