后路全脊椎切除术后脊柱畸形患者主弯各段Cobb角变化及其对主弯矫形的意义

Correlation and clinical significance between change of Cobb angle and correction of the major curve in patients undergoing posterior vertebral corpectomy

中文关键词:  脊柱畸形  后路全脊椎切除术  主弯  Cobb角

英文关键词:Spinal deformities  Posterior vertebral corpectomy  Major curve  Cobb angle

中文摘要:

  【摘要】 目的：探讨后路全脊椎切除术（PVC）后脊柱畸形患者主弯各段Cobb角变化、对主弯矫形的意义及主弯置钉情况对矫形效果的影响。方法：对应用PVC治疗的46例严重僵硬性脊柱畸形患者进行回顾性分析。根据患者术前及术后所摄标准脊柱全长前后位X线片，在冠状面将畸形主弯划分为主弯上段、主弯中段及主弯下段。采用标准Cobb角测量方法分别对术前、术后主弯及主弯各分段Cobb角进行测量。比较主弯及主弯各分段Cobb角的变化、计算主弯各分段对主弯矫形的贡献率并进行统计学分析，同时观察主弯段椎弓根置钉情况及切除椎紧邻上下椎体的置钉情况与矫形率的关系。结果：患者术前主弯Cobb角平均为110.1°±18.1°，术后平均减小59.1°±16.4°（P<0.05），主弯矫形率为（54.1±12.2）%。其中，主弯中段平均减小28.1°±14.7°（P<0.05），对主弯矫形的贡献率为（49.1±27.3）%，主弯上段平均减小15.7°±13.1°（P<0.05），对主弯矫形贡献率为（25.2±16.6）%，主弯下段平均减小15.3°±12.4°（P<0.05），对主弯的矫形贡献率为（26.3±22.6）%。主弯上、下两段的矫形度数及矫形贡献率无统计学差异（P>0.05）。在切除椎的相邻的上下椎体至少各置入一枚椎弓根螺钉的患者有22例，该组患者主弯中段的矫形度要明显优于上、下椎体无钉的24例患者（P<0.05）。同时发现主弯节段置钉比率与主弯矫形率密切相关（r=0.82，P<0.05）。结论：主弯中段对主弯矫形的贡献率最大，主弯内椎弓根螺钉置钉数对矫形起重要作用，尤其在切除椎的邻近椎体置钉对脊柱矫形及重建更重要。

英文摘要:

  【Abstract】 Objective：To investigate the correlation and clinical significance between change of Cobb angle and correction of the major curve in patients undergoing posterior vertebral corpectomy（PVC）， and the correlation between the placement of pedicle screw in major curve and the correction effect.Method：46 patients suffering from severe rigid spinal deformities undergoing PVC were retrospectively reviewed.All patients underwent standard anteroposterior entire spine radiograph before and after operation，the major curve at coronal plane was divided into three parts：upper，middle，and lower segment.The Cobb angle of each segment was measured.The changes of the Cobb angle for major curve and each segment before and after operation were analyzed and the relationship between the placement of pedicle screws and the correction rate was investigated.Result：The Cobb angle of major curve decreased from preoperative 110.1°±18.1° to postoperative 51.0°±17.3°（P<0.05），with the average correction rate of （54.1±12.2）%（P<0.05）.The middle segment decreased 28.1°±14.7°（P<0.05），with the contribution rate to major curve correction of （49.1±27.3）%.The upper and lower segment decreased 15.7°±13.1° and 15.3°±12.4° respectively（P<0.05），which showed no significant difference between them in contribution rate（25.2±16.6% vs 26.3±22.6%）（P>0.05）.22 patients had at least one pedicle screw in each of the adjacent upper and lower vertebrae of corpectomy，which ensured a better correction rate than otherwise（P<0.05）.Our data also indicated that deformity correction was closely related to the pedicle screw placement rate（r=0.82，P<0.05）.Conclusion：The middle segment contributes most to the major curve correction，the number of placed pedicle screws plays an important role to the correction，and pedicle screw placed adjacently is more important.