Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of VIP Clinic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Orthop Surg. 2023 Dec;15(12):3083-3091. doi: 10.1111/os.13891. Epub 2023 Sep 28.
Conventional correction techniques were challenging and of high risk of neurological complications for the correction of severe and rigid kyphoscoliosis. A new technical note we developed and named as sequential correction, was used to treat severe and rigid kyphoscoliosis. The present study was to compare the clinical outcomes of sequential correction versus conventional correction for the treatment of severe and rigid kyphoscoliosis.
This is a respectively case-control study. Between January 2014 and December 2019, 36 adults underwent the surgical correction of severe and rigid kyphoscoliosis and were included in the present study. Among them, 20 adults underwent conventional correction, 16 adults underwent sequential correction. Major curve Cobb angle, kyphotic angle, coronal imbalance, and sagittal vertical axis were compared between two groups. The patient-reported health-related quality of life outcomes, including the Oswestry disability index score, and SRS-22 questionnaire, were recorded. Independent samples t-test, Mann-Whitney U test, and Wilcoxon signed-rank test, were used to compare the differences between two groups according to the results of normal distribution test.
In conventional correction group, the mean major curve Cobb angle was 122.50° preoperatively, 40.35° immediately after surgery, and 43.95° at final follow-up postoperatively; the mean kyphotic angle was 97.45° preoperatively, 34.45° immediately after surgery, and 38.30° at final follow-up postoperatively. In the sequential correction group, the mean major angle was 134.44° preoperatively, 44.56° immediately after surgery, and 46.25° at final follow-up postoperatively; the mean kyphotic angle was 112.31° preoperatively, 39.00° immediately after surgery, and 40.38° at final follow-up postoperatively. The mean major curve Cobb angle and kyphotic angle of both groups were improved significantly, while there were no significant differences between two groups (p > 0.001). Improved self-reported quality of life scores were achieved postoperatively and at final follow-up postoperatively, and there were no significant differences between the two groups. The total complication rate of the patients underwent conventional correction was 55%, and the total complication rate of the patients underwent sequential correction was 43.75%. The complication rate of the two groups showed no significant difference.
Sequential correction is an excellent and safe treatment for severe and rigid kyphoscoliosis in adults, with similar clinical outcomes with conventional correction. The total complication rate of the patients who underwent sequential correction was slightly lower than conventional correction.
对于重度僵硬性脊柱后凸畸形的矫正，传统的矫正技术具有挑战性，且存在较高的神经并发症风险。我们开发了一种新技术，并将其命名为序贯矫正，用于治疗重度僵硬性脊柱后凸畸形。本研究旨在比较序贯矫正与传统矫正治疗重度僵硬性脊柱后凸畸形的临床疗效。
这是一项回顾性病例对照研究。2014 年 1 月至 2019 年 12 月，36 例成人接受了重度僵硬性脊柱后凸畸形的手术矫正，均纳入本研究。其中 20 例行传统矫正，16 例行序贯矫正。比较两组患者的主要弯曲 Cobb 角、后凸角、冠状面失衡和矢状面垂直轴。记录患者报告的健康相关生活质量结局，包括 Oswestry 残疾指数评分和 SRS-22 问卷。根据正态分布检验结果，采用独立样本 t 检验、Mann-Whitney U 检验和 Wilcoxon 符号秩检验比较两组间的差异。
在传统矫正组中，主要弯曲 Cobb 角术前平均为 122.50°，术后即刻为 40.35°，术后最终随访为 43.95°；后凸角术前平均为 97.45°，术后即刻为 34.45°，术后最终随访为 38.30°。在序贯矫正组中，主要弯曲 Cobb 角术前平均为 134.44°，术后即刻为 44.56°，术后最终随访为 46.25°；后凸角术前平均为 112.31°，术后即刻为 39.00°，术后最终随访为 40.38°。两组患者的主要弯曲 Cobb 角和后凸角均明显改善，两组间无显著差异（p>0.001）。术后和最终随访时，患者自我报告的生活质量评分均有改善，两组间无显著差异。传统矫正组患者的总并发症发生率为 55%，序贯矫正组患者的总并发症发生率为 43.75%。两组的并发症发生率无显著差异。
序贯矫正是治疗成人重度僵硬性脊柱后凸畸形的一种优秀且安全的方法，其临床疗效与传统矫正相似。序贯矫正组患者的总并发症发生率略低于传统矫正组。
