Song Mi Hyun, Yang Jae Hyuk, Chang Dong-Gune, Nam Yunjin, Suh Seung Woo
Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Korea University Medical Center, Anam Hospital, Seoul, Korea.
Neurospine. 2023 Sep;20(3):989-996. doi: 10.14245/ns.2346568.284. Epub 2023 Sep 30.
Osteotomies are required for the mobilization of spinal segments in patients with revisional scoliosis surgery with a fusion mass; however, only a few techniques have shown efficacy and safety, and their mid- and long-term outcomes remain unelucidated. This study aimed to analyze long-term outcomes of the posterior multilevel crack osteotomy (PMCO) technique for revisional surgery for scoliosis with a fusion mass.
Data from 18 patients who underwent revisional scoliosis surgery using PMCO between 2009 and 2015 and had more than 5-year follow-up were retrospectively reviewed. The Cobb angle and coronal and sagittal balance parameters were examined preoperatively, postoperatively, and during the final follow-up. Perioperative parameters and complications were also assessed.
Preoperative and postoperative Cobb angles were 60.5° and 29.9°, respectively (p < 0.001); this improvement was maintained until the final follow-up (33.4°, p = 0.058). The difference in preoperative and postoperative coronal balance was statistically significant (15.9 mm and 9.2 mm, respectively; p < 0.001); this was maintained until the final follow-up (p = 0.071). There was no change in sagittal balance parameters over the 3 measurement periods. Only 1 patient showed PMCO-related motor weakness, but he spontaneously recovered 3 months after postsurgery. Pseudarthrosis was not observed during the follow-up period.
Incomplete osteotomy using PMCO provided satisfactory deformity correction without severe complications during revisional surgery for scoliosis with a fusion mass. It may be a less invasive procedure that maintains cortical continuity, preserves soft tissues, and provides sufficient mobility for the correction of spinal segments.
在翻修性脊柱侧弯手术且存在融合块的患者中，需要进行截骨术来活动脊柱节段；然而，只有少数技术显示出有效性和安全性，其中长期疗效仍不明确。本研究旨在分析后路多级裂缝截骨术（PMCO）技术用于伴有融合块的脊柱侧弯翻修手术的长期疗效。
回顾性分析2009年至2015年间18例行PMCO翻修性脊柱侧弯手术且随访超过5年患者的数据。术前、术后及末次随访时检查Cobb角、冠状面和矢状面平衡参数。还评估围手术期参数和并发症。
术前和术后Cobb角分别为60.5°和29.9°（p<0.001）；这种改善一直维持到末次随访（33.4°，p=0.058）。术前和术后冠状面平衡差异有统计学意义（分别为15.9mm和9.2mm；p<0.001）；这种情况一直维持到末次随访（p=0.071）。在3个测量期内矢状面平衡参数无变化。仅1例患者出现与PMCO相关的运动无力，但术后3个月自行恢复。随访期间未观察到假关节形成。
在伴有融合块的脊柱侧弯翻修手术中，使用PMCO进行不完全截骨可提供满意的畸形矫正，且无严重并发症。它可能是一种侵入性较小的手术，可保持皮质连续性，保留软组织，并为脊柱节段的矫正提供足够的活动度。
