定量确定严重脊柱畸形的术前截骨计划：单中心 131 例 Yang 分型 A 型病例分析。
Quantitative determining of pre-operative osteotomy plan for severe spinal deformity: an analysis of 131 consecutive Yang's A type cases from single center.
机构信息
Department of Orthopaedic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
出版信息
Eur Spine J. 2021 Nov;30(11):3200-3208. doi: 10.1007/s00586-021-06840-1. Epub 2021 May 18.
PURPOSE
This study aimed to quantify osteotomy protocol for severe spinal deformity correction based on pre-operative demographic, clinical and radiologic parameters.
METHODS
A total of 131 Yang's A type severe spinal deformity patients were included. All patients received one of following osteotomies: Ponte/2 (Ponte osteotomy/Grade 2 osteotomy, n = 30), PSO/3 (pedicle subtraction osteotomy/Grade 3 osteotomy, n = 19), BDBO/4 (bone-disc-bone osteotomy/Grade 4 osteotomy, n = 26), SVCR/5 (single-level vertebral column resection/Grade 5 osteotomy, n = 38) and MVCR/6 (multilevel vertebral column resection/Grade 6 osteotomy, n = 18). Demographic, clinical and radiologic characteristics were compared among groups.
RESULTS
Tukey's test identified 6 significant variables between paired groups: age for MVCR/6 versus Ponte/2 + PSO/3 + BDBO/4 + SVCR/5 groups; bending Cobb angle for Ponte/2 versus MVCR/6; sagittal deformity angular ratio (S-DAR) for Ponte/2 + PSO/3 versus BDBO/3 + SVCR/5 versus MVCR/6; pre-operative scoliosis for Ponte/2 versus SVCR/5; total-DAR (T-DAR) and pre-operative kyphosis for Ponte/2 + PSO/3 versus BDBO/4 + SVCR/5 + MVCR/6. Receiver Operating Characteristic (ROC) analysis showed the Area under the Curve (AUC) for the 6 variables ranged from 0.69 to 0.839. Multivariate k-means clustering analysis showed that Ponte/2 + PSO/3, BDBO/4 + SVCR/5, and MVCR/6 were three comparatively significant clusters, which could be discriminated by pre-operative kyphosis, T-DAR, age and S-DAR.
CONCLUSION
This study showed that osteotomy plan of severe spinal deformity could be determined as follows: Firstly, Ponte/2 + PSO/3 and BDBO/4 + SVCR/5 + MVCR/6 groups can be divided by either T-DAR (cutoff = 28) or the Cobb angle of pre-operative maximum kyphosis (cutoff = 100). Secondly, Ponte/2 + PSO/3 group could be further dichotomized into Ponte/2 and PSO/3 by age (cutoff = 18). Finally, BDBO/4 + SVCR/5 + MVCR/6 group could be divided into BDBO/4 + SVCR/5 and MVCR/6 groups by S-DAR (cutoff = 20).
目的
本研究旨在根据术前人口统计学、临床和影像学参数，量化严重脊柱畸形矫正的截骨方案。
方法
共纳入 131 例 Yang 型 A 型严重脊柱畸形患者。所有患者均接受以下截骨术之一：Ponte/2（Ponte 截骨术/Grade 2 截骨术，n=30）、PSO/3（pedicle subtraction osteotomy/Grade 3 osteotomy，n=19）、BDBO/4（bone-disc-bone osteotomy/Grade 4 osteotomy，n=26）、SVCR/5（single-level vertebral column resection/Grade 5 osteotomy，n=38）和 MVCR/6（multilevel vertebral column resection/Grade 6 osteotomy，n=18）。比较各组的人口统计学、临床和影像学特征。
结果
Tukey 检验鉴定出 6 个配对组间有显著差异的变量：MVCR/6 与 Ponte/2+PSO/3+BDBO/4+SVCR/5 组间的年龄；Ponte/2 与 MVCR/6 组间的弯曲 Cobb 角；Ponte/2+PSO/3 与 BDBO/3+SVCR/5 与 MVCR/6 组间的矢状畸形角比（S-DAR）；Ponte/2 与 SVCR/5 组间的术前脊柱侧凸；Ponte/2+PSO/3 与 BDBO/4+SVCR/5+MVCR/6 组间的总-DAR（T-DAR）和术前后凸。受试者工作特征（ROC）分析显示，6 个变量的曲线下面积（AUC）范围为 0.69 至 0.839。多变量 k-均值聚类分析显示，Ponte/2+PSO/3、BDBO/4+SVCR/5 和 MVCR/6 是三个具有显著差异的聚类，可以通过术前后凸、T-DAR、年龄和 S-DAR 来区分。
结论
本研究表明，严重脊柱畸形的截骨方案可如下确定：首先，Ponte/2+PSO/3 和 BDBO/4+SVCR/5+MVCR/6 组可通过 T-DAR（截定点=28）或术前最大后凸 Cobb 角（截定点=100）来区分。其次，Ponte/2+PSO/3 组可进一步通过年龄（截定点=18）分为 Ponte/2 和 PSO/3。最后，BDBO/4+SVCR/5+MVCR/6 组可通过 S-DAR（截定点=20）分为 BDBO/4+SVCR/5 和 MVCR/6 组。
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