下位次顶椎截骨术治疗顶椎位于T12的退变性胸腰椎后凸畸形患者的中期疗效

Mid-term efficacy of inferior parietal osteotomy in the treatment of patients with degenerative thoracolumbar kyphosis with apex located at T12

中文关键词:  退变性脊柱后凸  胸腰椎  截骨术  临床疗效

英文关键词:Degenerative spinal kyphosis  Thoracolumbar  Osteotomy  Clinical efficacy

中文摘要:

  【摘要】 目的：探究下位次顶椎截骨术治疗顶椎位于T12的退变性胸腰椎后凸畸形患者的临床疗效。方法：回顾性分析2017年1月～2021年12月于我院行后路矫形融合术以及在顶椎下一位椎体行单节段经椎弓根椎体截骨术（pedicle subtraction osteotomy，PSO）治疗的29例胸腰段后凸畸形患者的临床及影像学资料。患者均为女性，后凸顶椎位于T12水平，平均年龄60.6±5.5岁，平均随访时间28.1±3.8个月。影像学评价指标包括术前、术后即刻及末次随访时于站立位全脊柱正侧位片上测量的全脊柱最大后凸Cobb角（global kyphosis，GK）、胸椎后凸角（thoracic kyphosis，TK）、胸椎交界性后凸角（thoracolumbar junctional kyphosis，TJK）、腰椎前凸角（lumbar lordosis，LL）、矢状面轴向距离（sagittal vertical axis，SVA）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、T1骨盆角（T1-pelvic angle，T1PA）。术前及末次随访时的生活质量评估采用脊柱侧凸研究学会-22简明量表调查问卷（Scoliosis Research Society-22 questionnaire，SRS-22）、腰椎僵硬功能障碍指数（lumbar stiffness disability index，LSDI）、Oswestry功能障碍指数（Oswestry disability index，ODI）、视觉模拟评分表（visual analog scale，VAS）。统计患者术中神经电生理监测事件（introoperative neurophysiological monitoring event，IONM）、术后神经功能损害及并发症等情况。结果：接受下位次顶椎截骨的患者矢状面GK由术前63.3°±11.3°矫正到术后的27.3°±8.3°（P<0.001），矫正率为（56.4±12.4）%，末次随访时GK为29.5°±8.4°，有（10.1±14.6）%的矫正丢失。TJK由术前的52.9°±10.2°矫正到术后的17.0°±3.3°（P<0.001），矫正率为（67.0±7.8）%，末次随访时TJK为16.9°±3.0°，与术后相比无显著差异（P=0.609）。SVA由术前44.3±34.1mm改善至术后20.4±23.6mm（P<0.001），末次随访时SVA为25.5±24.9mm，与术后相比无显著差异（P=0.086）。经过手术治疗，患者的术后生活质量较术前得到了明显提高，随访时的SRS-22（疼痛、形象、心理、活动功能）、ODI、VAS、LSDI等评分较术前具有显著统计学差异（P<0.001）。有2（6.9%）例患者出现了IONM事件,所有患者末次随访时未表现出神经功能损害相关的并发症，4例患者在随访时发生近端交界性后凸（proximal junction kyphosis，PJK）。未见感染、螺钉松动、断钉、断棒等其他并发症。结论：对于顶椎位于T12的退变性脊柱后凸的患者，行下位次顶椎截骨术矫形，不仅能够取得满意的临床疗效，而且提高了手术的安全性、降低术后并发症的风险。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical effect of inferior parietal osteotomy in the treatment of patients with degenerative thoracolumbar kyphosis with apex located at T12. Methods: The clinical and imaging data of 29 patients with thoracolumbar kyphosis treated with posterior correction and fusion as well as single segment pedicle subtraction osteotomy(PSO) at the inferior parietal level in our hospital from January 2017 to December 2021 were retrospectively analyzed. The patients were all female aged 60.6±5.5 years old, and were followed up for 28.1±3.8 months. Radiographic parameters including global kyphosis(GK), thoracic kyphosis(TK), thoracolumbar junctional kyphosis(TJK), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), T1-pelvic angle(T1PA) were measured in the standing radiographs before and after operation and at the final follow-up. Quality of life of the patients were evaluated by the Scoliosis Research Society-22 questionnaire(SRS-22), the lumbar stiffness disability index(LSDI), the Oswestry disability index(ODI) and the visual analog scale(VAS). Intraoperative neurophysiological monitoring events(IONM), postoperative neurologic damage, and complications were recorded. Results: The sagittal GK was corrected from 63.3°±11.3° preoperatively to 27.3°±8.3° postoperatively(P<0.001), and the correction rate was (56.4±12.4)%. At the final follow-up, the GK was 29.5°±8.4°, and the rate of correction loss was (10.1±14.6)%. TJK was corrected from 52.9°±10.2° preoperatively to 17.0°±3.3° postoperatively(P<0.001), and the correction rate was (67.0±7.8)%. The TJK at the final follow-up was 16.9°±3.0°, showing no significant difference from that after operation(P=0.609). SVA was improved from preoperatively 44.3±34.1mm to postoperatively 20.4±23.6mm(P<0.001), and it was 25.5±24.9mm at the final follow-up, which showed no significant difference compared with that after operation(P=0.086). After surgical treatment, the postoperative quality of life of the patients was significantly improved compared with that before surgery. The scores of SRS-22(pain, image, psychological, activity function), ODI, VAS and LSDI at final follow-up were significantly different from those before surgery(P<0.001). IONM events occurred in 2 patients(6.9%), and none of the patients showed neurologic impairment related complications after surgery. Four patients had proximal junction kyphosis(PJK) during follow-up period. Infection, screw loosening, screw fracture and rod fracture were not identified in the cohort. Conclusions: For patients with degenerative thoracolumbar kyphosis(apical vertebra at T12), PSO performed at one lower level of the apex vertebra not only can achieve satisfactory clinical results, but also improve the safety of the operation and reduce the risk of postoperative complications.