Song Di-Yu, Zhang Zi-Fang, Wang Tian-Hao, Qi Deng-Bin, Wang Yan, Zheng Guo-Quan
Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
Department of Orthopaedics, PLA Rocket Force Characteristic Medical Center, Beijing, China.
Orthop Surg. 2021 Dec;13(8):2396-2404. doi: 10.1111/os.13169. Epub 2021 Nov 24.
To describe spinal osteotomy in lateral position, which might be a new strategy for correcting thoracolumbar kyphotic deformity combined with severe hip flexion contracture, and to present two cases in which this method was successfully performed.
Spinal osteotomies in lateral position were performed in two patients with severe thoracolumbar kyphosis combined with hip flexion contracture, which was not suitable for operation in the prone position. Case 1: a 33-year-old female AS patient still had severe hip flexion contracture due to poor rehabilitation after total hip replacement (THR). The range of movement of the hip was only about 15° in right and 10° in left. Pre-operativethoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), and sagittal vertical axis (SVA) were 52.4°, 49.1°, 42.7°, and 315 mm, respectively. Pedicle subtraction osteotomy (PSO) at L3 was performed in the lateral position. The eggshell procedure was used during osteotomy. Case 2: a 45-year-old male AS patient presented coexisting rigid thoracolumbar kyphosis and hip flexion contracture. The range of movement of the hip was only about 20° in right and 25° in left. Pre-operativeTK, TLK, LL and SVA were 34.9°, 66.8°, 58.8° and 290.8 mm, respectively. PSO at L was performed in lateral position. The eggshell procedure was also used.
Sagittal malalignments of both patients were greatly improved. For case 1, the total operation time was 5.5 h. The blood loss was 1500 mL and the amount of allogeneic blood transfusion was 1580 mL during the operation. SVA was reduced to 127 mm and LL decreased from preoperative 42.7° to -28.4°. The correction angle through L was 34.7° and the correction angle through the osteotomy segment was 62.9°. For case 2, the duration of surgery was 6.5 h. The operative blood loss was 2000 mL and the total amount of blood transfusion was 2020 mL. SVA was reduced to 209.8 mm and LL decreased from preoperative 58.8° to 9.2°.The correction angle through L was 37.1° and the correction angle through the osteotomy segment was 55°. No intra-operative or post-operative complications were observed. Six months after PSO, case 1 had good posture for standing and sitting. The case 2 underwent bilateral THRs nine months after PSO.
PSO could be performed in the lateral position successfully. For AS patients who cannot be placed in the prone position due to coexisting severe thoracolumbar kyphosis and hip flexion contracture, performing spinal osteotomy in the lateral position as the first step is an alternative.
描述侧卧位脊柱截骨术，这可能是矫正胸腰段后凸畸形合并严重髋关节屈曲挛缩的一种新策略，并介绍成功实施该方法的两例病例。
对两名严重胸腰段后凸畸形合并髋关节屈曲挛缩且不适合俯卧位手术的患者实施侧卧位脊柱截骨术。病例 1：一名 33 岁女性强直性脊柱炎（AS）患者，全髋关节置换（THR）后康复不佳，仍有严重的髋关节屈曲挛缩。髋关节活动范围右侧约 15°，左侧约 10°。术前胸椎后凸（TK）、胸腰段后凸（TLK）、腰椎前凸（LL）和矢状垂直轴（SVA）分别为 52.4°、49.1°、42.7°和 315 mm。在侧卧位对 L3 进行椎弓根截骨术（PSO）。截骨过程中采用蛋壳技术。病例 2：一名 45 岁男性 AS 患者，同时存在僵硬的胸腰段后凸畸形和髋关节屈曲挛缩。髋关节活动范围右侧约 20°，左侧约 25°。术前 TK、TLK、LL 和 SVA 分别为 34.9°、66.8°、58.8°和 290.8 mm。在侧卧位对 L 进行 PSO。同样采用蛋壳技术。
两名患者的矢状面畸形均得到显著改善。病例 1，总手术时间为 5.5 小时。术中失血 1500 mL，异体输血 1580 mL。SVA 降至 127 mm，LL 从术前的 42.7°降至 -28.4°。通过 L 的矫正角度为 34.7°，通过截骨节段的矫正角度为 62.9°。病例 2，手术时长 6.5 小时。术中失血 2
