成人脊柱畸形的三柱截骨术：后凸畸形与后凸侧弯畸形的疗效及并发症比较
Three column osteotomy for adult spine deformity: comparison of outcomes and complications between kyphosis and kyphoscoliosis.
作者信息
Qiao Jun, Xiao Lingyan, Sun Xu, Liu Zhen, Zhu Zezhang, Qian Bangping, Qiu Yong
机构信息
a Department of Spine Surgery , the Affiliated Drum Tower Hospital of Nanjing University Medical School , Nanjing , China.
b Intensive Care Unit , the Second Hospital of Nanjing, Southeast University , Nanjing , China.
出版信息
Br J Neurosurg. 2018 Feb;32(1):32-36. doi: 10.1080/02688697.2018.1427214. Epub 2018 Jan 15.
BACKGROUND
To compare the surgical outcomes and complications between kyphosis and kyphoscoliosis when using three-column osteotomies.
METHODS
Adult spine deformity (ASD) patients with three column osteotomies from March 2005 to December 2014 in our center were retrospectively reviewed. Pre- and postoperative standing postero-anterior and lateral radiographs of the entire spine were obtained. Scoliosis Research Society-22 questionnaire [SRS-22] and Oswestry Disability Index [ODI] were administered preoperatively, postoperatively (surveys within 2 months after surgery), and at final follow-up. Patients were assigned to one of two groups according to pre-operative coronal curve magnitude: (1) if coronal curve <10°, patients were assigned to kyphosis group (K group); (2) if coronal curve >40°, patients were assigned to kyphoscoliosis group (S group).
RESULTS
33 ASD patients were assigned to the kyphosis group (K group), of which 26 received PSO (pedicle subtraction osteotomy) and 7 VCR (vertebral column resection). 76 patients were assigned to kyphoscoliosis group (S group), of which 50 received PSO and 26 VCR. Patients in the K group were significantly older than in the S group (42.8 vs. 33.7 years, p < .05). Significantly longer OT (operation time) and more EBL (estimated blood loss) were observed in the S group as compared to K group (OT: 282 vs. 205 min, p < .05; EBL: 1827 vs. 1214ml, p < .05). No significant difference was noted for number of fusion levels between the groups (12.4 vs. 12.7, p > .05). Pre-operative radiographic parameters demonstrated no difference of GK (global kyphosis) and SVA (sagittal vertical axis) between the two groups (GK: 74.7° vs 76.2°, p > .05; SVA:53.2 vs. 55.7mm, p > .05). K group had larger KF than S group (26% vs. 15%, p < .05). Overall complication rate was higher in S group than in K group (30.3% vs. 18.2%, p < .05). No difference of neurological complication rates between the two groups (9.1% vs. 10.5%, p > .05).
CONCLUSIONS
Kyphoscoliosis group had less KF, GK correction and more OT, EBL and surgical complications when receiving three column osteotomies.
背景
比较采用三柱截骨术治疗后凸畸形和脊柱后凸侧弯的手术效果及并发症。
方法
回顾性分析2005年3月至2014年12月在本中心接受三柱截骨术的成人脊柱畸形（ASD）患者。获取术前、术后全脊柱站立位正侧位X线片。术前、术后（术后2个月内调查）及最终随访时采用脊柱侧弯研究学会22项问卷[SRS-22]和奥斯维斯特残疾指数[ODI]进行评估。根据术前冠状面弯曲度数将患者分为两组：（1）若冠状面弯曲<10°，患者归入后凸畸形组（K组）；（2）若冠状面弯曲>40°，患者归入脊柱后凸侧弯组（S组）。
结果
33例ASD患者归入后凸畸形组（K组），其中26例行椎弓根截骨术（PSO），7例行全脊椎切除术（VCR）。76例患者归入脊柱后凸侧弯组（S组），其中50例行PSO，26例行VCR。K组患者年龄显著大于S组（42.8岁对33.7岁，p<0.05）。与K组相比，S组手术时间（OT）显著更长，估计失血量（EBL）更多（OT：282分钟对205分钟，p<0.05；EBL：1827毫升对1214毫升，p<0.05）。两组间融合节段数无显著差异（12.4对12.7，p>0.05）。术前影像学参数显示两组间总体后凸（GK）和矢状面垂直轴（SVA）无差异（GK：74.7°对76.2°，p>0.
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