Wang Hai, Wang Shengru, Wu Nan, Wang Shujie, Qiu Guixing, Zhang Jianguo
Department of Orthopaedic Surgery, 34732Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Global Spine J. 2022 Oct;12(8):1804-1813. doi: 10.1177/2192568221989291. Epub 2021 Feb 22.
Retrospective cohort study.
We aimed to evaluate the safety and validity of posterior vertebral column resection (pVCR) for severe thoracolumbar kyphosis (TLK) in the achondroplasia (ACH) patients.
Seven ACH patients (male: female = 6:1) who underwent pVCR procedures due to severe TLK from December 2008 to December 2017 in the authors' hospital were included in this retrospective study. Their mean follow-up duration was 67 ± 35 months. Their clinical characteristics, radiologic characteristics, surgical characteristics and surgical complications were reviewed.
A total of 8 vertebrae were removed with an average of 5 ± 2 levels of decompression and 9 ± 2 segments instrumented. The mean correction rates of TLKs and the main curves were 73 ± 15% and 87 ± 6%, respectively. Five patients (71%) had preoperative neurological symptoms with a mean Japanese Orthopedic Association (JOA) score of 8 ± 3 points. Their neurological functions were all improved, with a recovery rate of 78 ± 32% for the JOA score at the last follow-up. Four patients (57%) suffered from surgical complications, including rod breakages (43%), neurological complications (28%), dural tears (14%), cerebrospinal fluid leaks (14%) and proximal junction kyphosis (14%).
pVCR can offer a good correction for TLK and improve neurological function with extensive laminectomies in ACH patients. But the morbidity of surgical complications is relatively high. Therefore, it is a reserved surgical option for severe TLK in ACH patients by experienced spinal surgeons, especially with apical markedly hypoplastic vertebrae.
回顾性队列研究。
我们旨在评估后路脊柱椎体切除术（pVCR）治疗软骨发育不全（ACH）患者严重胸腰椎后凸畸形（TLK）的安全性和有效性。
本回顾性研究纳入了2008年12月至2017年12月在作者所在医院因严重TLK接受pVCR手术的7例ACH患者（男∶女 = 6∶1）。他们的平均随访时间为67±35个月。回顾了他们的临床特征、放射学特征、手术特征和手术并发症。
共切除8个椎体，平均减压5±2个节段，置入内固定9±2个节段。TLK和主要曲线的平均矫正率分别为73±15%和87±6%。5例患者（71%）术前有神经症状，日本骨科协会（JOA）平均评分为8±3分。他们的神经功能均得到改善，末次随访时JOA评分的恢复率为78±32%。4例患者（57%）出现手术并发症，包括棒断裂（43%）、神经并发症（28%）、硬脊膜撕裂（14%）、脑脊液漏（14%）和近端交界性后凸（14%）。
pVCR可为ACH患者的TLK提供良好的矫正，并通过广泛的椎板切除术改善神经功能。但手术并发症的发生率相对较高。因此，对于ACH患者的严重TLK，尤其是伴有顶椎明显发育不全的患者，这是一种由经验丰富的脊柱外科医生保留的手术选择。
