Chen H J, Liu Y, Wu X D, Cao P, Liang L, Wang J X, Gu Y F, Yuan W
Department of Spine Surgery, Changzheng Hospital, Shanghai 200003, China.
Zhonghua Yi Xue Za Zhi. 2019 Aug 6;99(29):2282-2287. doi: 10.3760/cma.j.issn.0376-2491.2019.29.007.
To investigate the surgical strategy and mid-and long-term outcomes of neurofibromatosis associated cervical kyphotic deformity. Thirteen patients with neurofibromatosis associated cervical kyphotic deformity operated in Shanghai Changzheng Hospital from January 1998 to December 2015 were analyzed retrospectively. There were 7 males and 6 females in this group, aged from 12 to 61 years, with an average age of (28±15) years. Eight patients were treated with anterior surgery (Group A) and 5 patients were treated with combined anterior and posterior surgery (Group A+P). Cobb angle correction of cervical kyphosis and improvement of clinical symptoms were followed up. Clinical efficacy between the two groups was compared and analyzed. Chi-square test, Fisher exact test and independent sample test were used for comparative analysis between the two groups. All patients were operated successfully and finished follow up. The follow-up period was from 42 to 128 months ((80±22) months). After the surgery, neurological symptoms and pain were significantly improved in all patients. Compared with preoperative values, Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score for pain at the last follow-up were significantly improved (7.63, -5.19, 8.63, -4.75, all 0.01). Cervical kyphosis was significantly improved in all patients after surgery. In group A, the Cobb angle was improved from 64°±24° preoperatively to 12°±11° at the last follow-up, and the average correction rate of Cobb angle was 82.6%. In group A+P, the Cobb angle was improved from 55°±10° preoperatively to 7°±9° at the last follow-up, and the average correction rate of Cobb angle was 88.3%. The operation time, intraoperative blood loss and length of stay in group A were all significantly lower than those in group A+P (-6.32, -11.92, -6.52, all 0.01). At the last follow-up, there was no significant difference in Cobb angle, JOA score and VAS score between the two groups (0.89, 0.94, 1.02, all 0.05). Mid-and long-term results of anterior and combined anterior and posterior surgery for neurofibromatosis associated severe cervical kyphosis are satisfactory. Moderate correction strategy for cervical kyphosis is safe and effective. The incidence of complications of nerve injury can be reduced.
探讨神经纤维瘤病相关颈椎后凸畸形的手术策略及中长期疗效。回顾性分析1998年1月至2015年12月在上海长征医院接受手术治疗的13例神经纤维瘤病相关颈椎后凸畸形患者。该组患者中男性7例，女性6例，年龄12至61岁，平均年龄（28±15）岁。8例患者接受前路手术（A组），5例患者接受前后路联合手术（A+P组）。随访颈椎后凸畸形的Cobb角矫正情况及临床症状改善情况。比较分析两组间的临床疗效。采用卡方检验、Fisher确切概率法和独立样本t检验进行两组间的对比分析。所有患者手术均成功并完成随访。随访时间为42至128个月（（80±22）个月）。术后所有患者神经症状及疼痛均明显改善。与术前相比，末次随访时日本骨科学会（JOA）评分及疼痛视觉模拟评分（VAS）均明显改善（分别为7.63、-5.19、8.63、-4.75，P均＜0.01）。术后所有患者颈椎后凸均明显改善。A组Cobb角由术前64°±24°改善至末次随访时12°±11°，Cobb角平均矫正率为82.6%。A+P组Cobb角由术前55°±10°改善至末次随访时7°±9°，Cobb角平均矫正率为88.3%。A组手术时间、术中出血量及住院时间均明显低于A+P组（分别为-6.32、-11.92、-6.52，P均＜0.01）。末次随访时，两组间Cobb角、JOA评分及VAS评分差异均无统计学意义（分别为0.89、0.94、1.02，P均＞0.05）。前路及前后路联合手术治疗神经纤维瘤病相关重度颈椎后凸畸形的中长期疗效满意。颈椎后凸的适度矫正策略安全有效。可降低神经损伤并发症的发生率。
