三柱截骨术与头环重力牵引联合后柱截骨术治疗1型营养不良性神经纤维瘤病性脊柱侧凸：一项回顾性比较队列研究
Three-column osteotomy versus Halo-gravity traction combined with posterior column osteotomy in the treatment of dystrophic neurofibromatosis type 1 kyphoscoliosis: a retrospective comparative cohort study.
作者信息
Lo Yuan-Shun, Dai Yu-Tong, Qiu Yong, Lin Erh-Ti Ernest, Hsieh Hung-Lun, Wei Xue-Peng, Tsai Chun-Hao, Fong Yi-Chin, Chen Hsien-Te, Tzeng Shiau-Tzu, Shi Ben-Long
机构信息
Division of Spine Surgery, Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan.
Division of Spine Surgery, Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan.
出版信息
J Orthop Surg Res. 2025 May 16;20(1):470. doi: 10.1186/s13018-025-05842-9.
BACKGROUND
Dystrophic neurofibromatosis type I (NF1) kyphoscoliosis presents unique challenges for corrective spinal surgery due to anatomical abnormalities. To compare the radiographic and clinical outcomes of dystrophic neurofibromatosis type 1 (NF1) kyphoscoliosis patients undergoing three-column osteotomy (3CO), halo-gravity traction (HGT), or posterior column osteotomy (PCO) and to evaluate their efficacy and safety in this cohort, different treatment strategies and their associated complication rates warrant further comprehensive investigation.
METHODS
Dystrophic NF1 kyphoscoliosis were divided into 3CO, HGT, and PCO groups based on the surgical strategy. Radiographic parameters were measured preoperatively, postoperatively, and at each follow-up. Intraoperative and postoperative complications were recorded for each patient, and patient-reported outcomes were assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire. Differences among the three groups were analyzed.
RESULTS
A total of 9 patients were included in the 3CO, 22 in HGT group, 95 in PCO groups, respectively. Significant differences among the three groups were found in terms of operation time (p = 0.011), estimated blood loss (p = 0.003), and number of satellite rod techniques (p = 0.013). At pre-operation, the Cobb angles of main curves were 84.3 ± 24.6° in 3CO group, 99.1 ± 24.3° in HGT group, 60.0 ± 16.8° in PCO group. At post-operation, significant post-operative improvements were found in the Cobb angles of the main curves, apical vertebral translation (AVT), segmental kyphosis (SK), and deformity angular ratio (DAR) in all three groups (p < 0.001). No significant correction loss was observed during the follow-up. Six complications were found in the 3CO group, 13 in the HGT group, and 40 in the PCO group.
CONCLUSIONS
PCO, 3CO, and HGT could be applied to dystrophic NF1 patients. The 3CO is also associated with increased perioperative complications.
LEVEL OF EVIDENCE
IV.
背景
由于解剖结构异常，I型营养不良性神经纤维瘤病（NF1）所致脊柱侧凸给脊柱矫正手术带来了独特挑战。为比较接受三柱截骨术（3CO）、头环重力牵引术（HGT）或后柱截骨术（PCO）的I型营养不良性神经纤维瘤病（NF1）脊柱侧凸患者的影像学和临床结果，并评估这些治疗策略在该队列中的疗效和安全性，不同治疗策略及其相关并发症发生率值得进一步全面研究。
方法
根据手术策略将营养不良性NF1脊柱侧凸患者分为3CO组、HGT组和PCO组。在术前、术后及每次随访时测量影像学参数。记录每位患者的术中及术后并发症，并使用脊柱侧凸研究学会22项问卷（SRS-22）评估患者报告的结果。分析三组之间的差异。
结果
3CO组共纳入9例患者，HGT组22例，PCO组95例。三组在手术时间（p = 0.011）、估计失血量（p = 0.003）和卫星棒技术使用次数（p = 0.013）方面存在显著差异。术前，3CO组主弯Cobb角为84.3±24.6°，HGT组为99.1±24.3°，PCO组为60.0±16.8°。术后，三组主弯Cobb角、顶椎平移（AVT）、节段性后凸（SK）和畸形角比（DAR）均有显著改善（p < 0.001）。随访期间未观察到明显的矫正丢失。3CO组发现6例并发症，HGT组13例，PCO组40例。
结论
PCO、3CO和HGT均可应用于营养不良性NF1患者。3CO还与围手术期并发症增加有关。
证据级别
IV级。
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