远端次顶椎后移旋转截骨矫形治疗脊柱重度角状后凸畸形的中期疗效

Mid-term clinical outcomes of posterior shift combined with rotational osteotomy at distal subapical vertebra in the treatment of severe angular kyphosis

中文关键词:  角状后凸畸形  次顶椎  后移旋转截骨矫形

英文关键词:Angular kyphosis  Subapical vertebra  Posterior shift combined with rotational osteotomy

中文摘要:

  【摘要】 目的：评估远端次顶椎后移旋转截骨矫形治疗脊柱重度角状后凸畸形的临床疗效。方法：回顾性分析2016年10月～2022年5因脊柱重度角状后凸畸形在我科行顶椎远端次顶椎后移旋转截骨矫形手术治疗的病例35例，其中男性23例，女性12例，年龄30.8±12.4岁（15～61岁）；合并神经损害的13例，随访时间2～6年，平均随访3.5年；患者均于矫形手术前、术后即刻、术后2年随访时拍摄站立位脊柱全长正侧位X线片，评估指标为脊柱后凸角度、矢状面轴向距离（sagittal vertical axis，SVA）、矢状面顶椎偏距；通过患者术前、术后2周、术后6个月神经功能Frankel分级情况评估神经功能恢复情况。结果：35例患者均顺利完成手术，脊柱后凸Cobb角由术前104.6°±13.2°减小至术后即刻32.1°±18.4°，改善率为69.3%，SVA由术前4.9±4.4cm减小至术后即刻2.6±1.5cm；矢状位顶椎偏距由术前10.9±2.0cm减小至术后即刻5.5±1.4cm；手术前后比较P＜0.05。末次随访神经损害的13例中12例改善，1例较术前无变化。结论：远端次顶椎后移旋转截骨矫形治疗脊柱重度角状后凸畸形，可以获得良好的矫形效果，为脊柱重度脊柱角状后凸畸形的治疗提供了一种新的术式选择。

英文摘要:

  【Abstract】 Objectives: To assess the midterm efficacy of distal subapical vertebra posterior shift combined with rotational osteotomy for severe angular kyphosis correction. Methods: A retrospective analysis was conducted on the clinical data of 35 patients with severe spinal angular kyphosis who underwent posterior shift combined with rotational osteotomy at distal subapical vertebra in our department from October 2016 to May 2022. There were 23 males and 12 females, the average age was 30.8±12.4 years(15-61 years), with 13 cases combined with nerve damage. Follow-up duration ranged from 2 to 6 years(mean 3.5 years). Full-length anteroposterior and lateral X-ray examination of the spine in a standing position was performed before operation, immediately after orthopedic surgery, and at 2-year follow-up, and the kyphotic angle, sagittal vertical axis(SVA), as well as sagittal apex deviation were measured and evaluated. The recovery of neurological function was evaluated by the Frankel classification of neurological function before operation, and at 2 weeks and 6 months after operation. Results: All 35 patients successfully underwent the surgery, resulting in a significant decrease in the kyphotic Cobb angle from 104.6°±13.2° preoperatively to 32.1°±18.4° postoperatively(P<0.05), with an improvement rate of 69.3%. Additionally, the SVA decreased from 4.9±4.4cm before surgery to 2.6±1.5cm after surgery immediately(P<0.05), and the sagittal apex deviation decreased from 10.9±2.0cm to 5.5±1.4cm(P<0.05). Furthermore, 12 out of the 13 patients with nerve damage showed improvement at the final follow-up assessment, 1 case showed no change compared with that before operation. Conclusions: Posterior shift combined with rotational osteotomy at distal subapical vertebra in the management of severe angular kyphosis can yield favorable orthopedic outcomes, which serves as a novel surgical option for managing severe angular spinal kyphosis.