后路经椎间隙截骨的临床分型及应用

Clinical classification of posterior trans-intervertebral space osteotomy in kyphotic and scoliokyphotic spinal deformity

中文关键词:  经椎间隙截骨  脊柱截骨矫形术  分型

英文关键词:Trans-intervertebral space osteotomy  Spinal osteotomy  Osteotomy classification

中文摘要:

  【摘要】 目的：介绍脊柱后路经椎间隙截骨术（trans-intervertebral space osteotomy，TIO）的技术理念、临床分型和应用策略。方法：根据TIO技术特点、手术操作过程中截骨切除范围所涉及的解剖结构，将其分为3大类型及2种扩大（+）型：围绕椎间盘及关节突关节为Ⅰ型，扩大至楔形切除椎间隙一侧终板为Ⅱ型（头尾双侧终板则为Ⅱ+型）。扩大至楔形切除椎间隙一侧椎弓根为Ⅲ型（双侧椎弓根则为Ⅲ+型）；收集2003年1月~2012年12月接受后路经椎间隙截骨术治疗的30例胸腰椎侧后凸畸形患者的临床资料，其中男12例，女18例，年龄29~69岁（51.4±10.4岁）。由5位脊柱外科医师先后对患者的临床资料进行独立评估与分型（间隔2周），进行Kappa一致性检验以分析其可信度及可重复性。结果：30例患者中行Ⅰ型TIO 15例，Ⅱ型TIO 6例，Ⅱ+型TIO 3例，Ⅲ型TIO 4例，Ⅲ+型TIO 2例。观察者间一致性的Kappa系数0.806~0.953；观察者内一致性的Kappa系数为0.837~0.953，可信度及可重复性满意。结论：经椎间隙截骨临床分型实用可靠，可作为理论基础用于比较不同研究中经椎间隙截骨技术的手术效果，有利于指导脊柱侧后凸畸形的截骨矫形治疗。

英文摘要:

  【Abstract】 Objectives: To clarify the definition of trans-intervertebral space osteotomy (TIO) and to propose a clinical classification of TIO based on the extent of osseous resection. Methods: The clinical data of 30 patients of kyphotic and kyphoscoliotic spinal deformity underwent TIO correction surgery from January 2003 to December 2012 [12 males and 18 females, aged from 29 to 69 years old (51.4±10.4 years old)] were included. According to the intraoperative extent of osseous resection andthe involvedanatomical structures,the TIO was classified into three main types and two additional subtypes (plus type): type Ⅰ, the resection included posterior facet joints with or without the intervertebral disc; type Ⅱ, the resection included the facet joints, intervertebral disc, and bony wedge of adjacent vertebra including either adjacent endplate; type Ⅲ, the resection included facet joints, intervertebral disc, and bony wedge of inferior vertebra including pedicle. The type Ⅱ and type Ⅲ had plus type (+ type), respectively. Five spinal surgeons evaluated and classified the cases in sequence according to the above-mentioned classification to collect the evaluation data. Two weeks later, the same five surgeons conducted a second evaluation and classified all the same cases in a different order and their evaluation results were collected again. Fleiss′ Kappa coefficients were performed to evaluate the reliability and reproducibility of the classification. Results: There were 15 cases of type Ⅰ TIO, 6 cases of type Ⅱ, 3 cases of type Ⅱ+, 4 cases of type Ⅲ and 2 cases of type Ⅲ+ among the 30 cases. The inter-observer reliability with a Kappa coefficient of 0.806-0.953; the inter-observer reliability with a Kappa coefficient of 0.837-0.953, indicating a satisfying reliability and reproducibility. Conclusions: The proposed clinical TIO classification was practical and validated reliable. It could be utilized for outcome analyze for studies of various TIO techniquesas basic theory, which contributing to the surgical treatment of kyphotic and scoliokyphotic spinal deformity.