后路全椎节切除、双轴旋转矫形手术治疗重度陈旧结核性后凸的疗效分析

Posterior vertebral column resection with dual axial rotation correction for severe kyphosis secondary to tuberculosis

中文关键词:  陈旧结核性脊柱后凸  全椎节切除截骨  双轴旋转  后凸矫形

英文关键词:Post-tuberculosis kyphosis  Vertebral column resection  Dual axial rotation  Kyphosis correction

中文摘要:

  【摘要】 目的：分析后路全椎节切除、双轴旋转矫形手术治疗重度陈旧结核性后凸的手术效果，探讨影响疗效的因素。方法：2004年5月～2011年9月，采用后路全椎节切除、双轴旋转矫形固定融合术治疗重度陈旧结核性后凸畸形患者33例。男15例，女18例；平均年龄34.7±14.1岁（11~63岁），其中年龄≥35岁18例，＜35岁15例；术前平均后凸角98.9°±18.2°（70.0°~130.0°），其中≥100°者17例，＜100°者16例；后凸顶点位于上中胸椎（T10及以上）19例，胸腰段及腰椎（T11及以下）14例。脊髓损伤Frankel分级A、B级各1例，C级5例，D级12例，E级14例。ODI术前平均19.5±9.4分。根据年龄、后凸顶点位置、后凸角度、术前Frankel分级、有无并发症等情况进行分组。对所有患者行手术前后及末次随访时的后凸局部和全脊柱正侧位X线摄片，测量后凸Cobb角，对合并侧凸的患者测量侧凸Cobb角。对手术前和随访时的患者进行脊柱矢状位平衡测量、实际身高测量、Frankel神经功能分级、Oswestry评分、VAS评分和手术PSI满意指数的评定。总结患者术中和术后并发症，并积极采取相应处理。结果：所有患者术前平均后凸Cobb角98.9°±18.2°，术后平均为30.9°±11.3°，矫正率为69.1%，末次随访时平均为34.8°±15.1°，矫正率为65.3%。患者脊柱矢状位平衡、身高测量、神经功能Frankel分级、生活质量Oswestry评分、腰背痛VAS评分均改善，手术总体满意率为87.9%。并发症发生率为54.5%，其中术中并发症12例、术后短期并发症2例、术后中远期并发症4例。所有并发症均及时采取相应处理。发生并发症者的总体后凸矫正率与未发生并发症者相当，但严重神经并发症发生者在神经功能恢复和生活质量改善方面均明显不如无并发症者。结论：后路全椎节切除、双轴旋转矫形手术是治疗重度陈旧结核性后凸畸形的有效方法，可以获得较好的手术效果，但需要尽量防止严重神经并发症的发生。

英文摘要:

  【Abstract】 Objectives: To observe the results of posterior vertebral column resection with dual axial rotation correction for severe kyphosis secondary to tuberculosis. Methods: From May 2004 to September 2011, 33 cases with severe kyphosis secondary to tuberculosis underwent posterior vertebral column resection with dual axial rotation correction were reviewed retrospectively. There were 15 males and 18 females; the average age was 34.7±14.1 years(11-63 years), with 18 cases ≥35 years and 15 cases ＜35 years; the preoperation Cobb angle was 98.9°±18.2°(70.0°-130.0°), with 17 cases ≥100° and 16 cases ＜100°; the posterior convex apex located at the upper middle thoracic spine(T10 and upper) was noted in 19 cases, at the thoracolumbar or lumbar spine(T11 and under) in 14 cases. The spinal cord injury of Frankel grade of A and B was noted in 1 case, grade C in 5 cases, grade D in 12 cases, grade E in 14 cases. The preoperation ODI was 19.8±10.0. Cases were subgrouped on the basis of age, location of kyphosis apex, severity of kyphosis, Frankel grade, complication situation. The kyphosis angle was measured before and after surgery, as well as final follow-up. The sagittal balance condition of the spine, the height of person, the Frankel grading system for neurological function of lower extremities, the Oswestry disability index(ODI) for life quality, the visual analogue score(VAS) for low back pain and the patient satisfactory index(PSI) were recorded before surgery and at follow-up. The intra- and post-operative complications were summarized, and the relevant management undertaken was noted. Results: The average kyphosis angle was 98.9°±18.2° before surgery and decreased to 30.9°±11.3° after surgery, with a correction rate of 69.1%. The average kyphosis angle was 34.8°±15.1° at the final follow-up, with a correction rate of 65.3%. The sagittal balance of the spine, height of person, Frankel grade, Oswestry disability index and visual analogue score were improved to a certain extent. The PSI results showed a satisfying rate of 87.9%. The complications included 12 cases at intraoperation, 2 cases at early-stage and 4 cases at late-stage. The incidence rate of complications was 54.5% and all complications got good relief after the relevant intervention. The correction rate of kyphosis angle was not different between patients with and without complications, but the life quality and neurological function improvement were lower in patients with serious neurological complications. Conclusions: Posterior vertebral column resection with dual axial rotation correction and fusion is an effective way to treat severe kyphosis secondary to tuberculosis, good therapeutic efficacy and long-term prognosis can be obtained. It is very important to prevent the occurrence of serious neurological complications.