Yuan Hao, Wang Minglang, Lei Fei, Zheng Lipeng, Chen Zan, Feng Daxiong
Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Orthopedics Department, Yanjiang District People's Hospital of Ziyang, Ziyang, China.
World Neurosurg. 2024 Nov;191:e62-e71. doi: 10.1016/j.wneu.2024.08.040. Epub 2024 Aug 12.
Razorback deformity with stiff thoracic scoliosis creates a complex three-dimensional deformity. Posterior spinal fusion (PSF) and thoracoplasty can correct rib hump deformity and improve patient satisfaction. However, conventional thoracoplasty may impair pulmonary function and increase complications. We present a modified thoracoplasty (MTP) technique for addressing rib hump deformity in stiff thoracic scoliosis patients, emphasizing its clinical efficacy and safety.
This study included 44 patients with stiff thoracic scoliosis and razorback deformity who underwent surgery between January 2010 and May 2021. Patients were divided into PSF + MTP (n = 27) and PSF (n = 17) groups. Surgical parameters, complications, radiographic improvements, pulmonary function, and Scoliosis Research Society-22 scores were evaluated preoperatively and at 3 months and 2 years postoperatively.
There were no significant differences in baseline characteristics between the 2 groups, except for the rib hump height, which was higher in the PSF + MTP group. The PSF + MTP group showed superior correction of the thoracic curve and rib hump height compared to the PSF group, with significant improvements in self-image scores. No significant differences were observed in pulmonary function between the groups. The operative time was longer in the PSF + MTP group, but there were no significant differences in intraoperative blood loss, hospitalization costs, or major complications. Regression analysis indicated that the type of surgery, thoracic Cobb angle, and preoperative self-image scores were significant predictors of postoperative self-image scores.
MTP provides enhanced correction of thoracic curve and rib hump deformity without significantly increasing pulmonary function impairment or complication rates. It also improves patients' self-image, making it a valuable addition to PSF in treating stiff thoracic scoliosis with rib hump deformity.
伴有僵硬胸椎侧弯的剃刀背畸形会造成复杂的三维畸形。后路脊柱融合术（PSF）和胸廓成形术可矫正肋骨隆突畸形并提高患者满意度。然而，传统的胸廓成形术可能会损害肺功能并增加并发症。我们提出一种改良胸廓成形术（MTP）技术，用于解决僵硬胸椎侧弯患者的肋骨隆突畸形，强调其临床疗效和安全性。
本研究纳入了2010年1月至2021年5月期间接受手术的44例伴有剃刀背畸形的僵硬胸椎侧弯患者。患者被分为PSF + MTP组（n = 27）和PSF组（n = 17）。术前以及术后3个月和2年评估手术参数、并发症、影像学改善情况、肺功能以及脊柱侧弯研究学会-22评分。
两组间基线特征无显著差异，但PSF + MTP组的肋骨隆突高度更高。与PSF组相比，PSF + MTP组在胸椎曲度和肋骨隆突高度矫正方面表现更优，自我形象评分有显著改善。两组间肺功能无显著差异。PSF + MTP组的手术时间更长，但术中出血量、住院费用或主要并发症方面无显著差异。回归分析表明，手术类型、胸椎Cobb角和术前自我形象评分是术后自我形象评分的重要预测因素。
MTP在不显著增加肺功能损害或并发症发生率的情况下，能更好地矫正胸椎曲度和肋骨隆突畸形。它还能改善患者的自我形象，使其成为PSF治疗伴有肋骨隆突畸形的僵硬胸椎侧弯的一项有价值的补充。
