Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central-South University, Changsha, China.
Orthop Surg. 2021 May;13(3):1016-1025. doi: 10.1111/os.13016. Epub 2021 Apr 7.
To (i) introduce the deformed complex vertebral osteotomy (DCVO) technique for the treatment of severe congenital angular spinal kyphosis; (ii) evaluate the sagittal correction efficacy of the DCVO technique; and (iii) discuss the advantages and limitations of the DCVO technique.
Multiple malformed vertebrae were considered a malformed complex, and large-range and angle wedge osteotomy was performed within the complex using the DCVO technique. Patients with local kyphosis greater than 80° who were treated with DCVO and did not have tumors, infections, or a history of surgery were included. A retrospective case study was performed in these patients with severe angular kyphosis who underwent the DCVO technique from 2008 to 2016. Demographic data, the operating time, and the volume of intraoperative blood loss were collected. Spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], and sacral slope [SS]), local and global sagittal parameters (deformity angle, thoracic kyphosis [TK], and lumbar lordosis [LL]), visual analog scale (VAS) score, and Oswestry disability index (ODI) score were recorded pre- and postoperatively. Paired t-tests (α = 0.05) were used for all data (to compare the mean preoperative value with the mean postoperative and most recent follow-up values). P < 0.05 was considered statistically significant.
Twenty-nine patients with a mean age of 34 years (range, 15-55) were included in the final analysis. Seventeen patients were male, and 12 were female. The mean follow-up was 44 months (range, 26-62). The mean operating time was 299 min (range, 260-320 min). The mean blood loss was 2110 mL (range, 1500-2900 mL). Three patients had T -T deformities (3/29, 10.3%), six had T -T deformities (6/29, 20.7%), six had T -T deformities (6/29, 20.7%), 10 had T -T deformities (10/29, 34.5%), three had T -T deformities (3/29, 10.3%), and one had T -T deformities (1/29, 3.4%). The mean local deformity angle significantly improved from 94.9° ± 10.8° to 24.0° ± 2.3° through the DCVO technique, with no significant loss at the follow-up. Moreover, the global sagittal parameters and spinopelvic parameters exhibited ideal magnitudes of improvement; TK decreased from 86.1° ± 12.1° to 28.7° ± 2.5°, LL improved from 94.5° ± 4.1° to 46.1° ± 3.0°, and PI minus LL improved from -60.9° ± 6.5° to -13.7° ± 2.6°. Both the VAS and ODI scores significantly improved at the last follow-up. CSF fistula and neural injury did not occur during the perioperative period. At the last follow-up, fixation failure was not observed.
The DCVO technique provides an alternative and effective method for the treatment of congenital severe angular spinal kyphotic deformities and may decrease the occurrence of perioperative complications.
（i）介绍用于治疗严重先天性成角脊柱后凸的变形复杂椎体截骨术（DCVO）技术；（ii）评估 DCVO 技术的矢状面矫正效果；（iii）讨论 DCVO 技术的优点和局限性。
多个畸形椎体被认为是畸形复合体，使用 DCVO 技术在复合体中进行大范围和角度楔形截骨。纳入接受 DCVO 治疗且局部后凸角大于 80°，无肿瘤、感染或手术史的患者。对 2008 年至 2016 年间接受 DCVO 技术治疗的严重成角后凸患者进行回顾性病例研究。收集患者的人口统计学数据、手术时间和术中出血量。记录脊柱骨盆参数（骨盆入射角[PI]、骨盆倾斜角[PT]和骶骨倾斜角[SS]）、局部和整体矢状面参数（畸形角、胸椎后凸角[TK]和腰椎前凸角[LL]）、视觉模拟量表（VAS）评分和 Oswestry 功能障碍指数（ODI）评分。使用配对 t 检验（α=0.05）对所有数据（比较术前均值与术后和最近随访的均值）进行分析。P<0.05 为差异有统计学意义。
最终分析纳入 29 例平均年龄为 34 岁（范围，15-55 岁）的患者。17 例为男性，12 例为女性。平均随访时间为 44 个月（范围，26-62 个月）。平均手术时间为 299 分钟（范围，260-320 分钟）。平均出血量为 2110 毫升（范围，1500-2900 毫升）。3 例存在 T-T 畸形（3/29，10.3%），6 例存在 T-T 畸形（6/29，20.7%），6 例存在 T-T 畸形（6/29，20.7%），10 例存在 T-T 畸形（10/29，34.5%），3 例存在 T-T 畸形（3/29，10.3%），1 例存在 T-T 畸形（1/29，3.4%）。通过 DCVO 技术，局部畸形角从 94.9°±10.8°显著改善至 24.0°±2.3°，随访时无明显丢失。此外，整体矢状面参数和脊柱骨盆参数均表现出理想的改善幅度；TK 从 86.1°±12.1°降低至 28.7°±2.5°，LL 从 94.5°±4.1°改善至 46.1°±3.0°，PI-LL 从-60.9°±6.5°改善至-13.7°±2.6°。VAS 和 ODI 评分在末次随访时均显著改善。围手术期未发生脑脊液漏和神经损伤。末次随访时，未观察到固定失败。
DCVO 技术为治疗先天性严重成角脊柱后凸提供了一种替代且有效的方法，可能降低围手术期并发症的发生。
