后路脊柱去松质骨截骨治疗Pott′s角状后凸畸形的安全性及有效性

The safety and reliability of posterior vertebral column decancellation for the management of Pott′s sharp kyphosis deformity

中文关键词:  Pott′s畸形  后凸  脊柱去松质骨截骨  骨性cage

英文关键词:Pott′s deformity  Kyphosis  Vertebral column decancellation  Bony cage

中文摘要:

  【摘要】 目的：探讨不使用传统钛网支撑植骨的后路脊柱去松质骨截骨术（posterior vertebral column decancel?鄄lation，PVCD）治疗Pott′s角状后凸畸形的安全性及有效性。方法：回顾性分析2010年8月~2014年5月于我院行PVCD治疗且资料完整的26例Pott′s角状后凸畸形患者的临床资料，其中男11例，女15例，年龄24.8±7.6岁（14~46岁）。后凸顶点位于胸椎6例，胸腰段18例，腰椎2例。术前ASIA分级C级1例，D级4例，E级21例。记录并分析手术前后及末次随访时的后凸Cobb角、顶椎区域前柱和后柱长度变化、手术时间、术中出血量、手术并发症。结果：手术时间为306.2±59.5min（200~420min），术中出血量为2046.2±742.4ml（1000~4000ml）。5例患者围手术期出现并发症，其中一过性神经症状2例，脑脊液漏3例。术前后凸Cobb角为91.3°±17.5°（66°~140°），术后为17.1°±6.2°（4°~30°），矫正74.2°±18.1°，矫正率为（80.9±6.6）%。截骨部位前柱增加3.6±3.1cm（0~8.4cm），后柱短缩2.7±1.1cm（1.3~4.8cm）。所有患者均获随访，随访时间为30.8±16.5个月（12~60个月）。末次随访时后凸Cobb角为20.3°±6.1°（9°~33°），矫正平均丢失3%。末次随访ASIA分级C级患者恢复为D级，3例D级患者恢复为E级，1例D级患者无恢复。结论：不使用传统钛网支撑植骨的PVCD技术是治疗Pott′s后凸畸形的一种安全有效的方法。

英文摘要:

  【Abstract】 Objectives: To explore the safety and effectiveness of bony cage rather than titanium mesh in posterior vertebral column decancellation(PVCD) in the management of Pott′s sharp kyphosis deformity. Methods: Prospective analysis of 26 patients with Pott′s deformity underwent PVCD from August 2010 to May 2014, with a minimun follow-up of 1 year and a maximun follow-up of 5 years. There were 11 males and 15 females with an average age of 24.8±7.6 years old. Among them, the number of apical vertebrae located in thoracic region, thoracolumbar region and lumbar region was 6, 18 and 2, respectively. 1 patient was in grade C, 4 patients were in grade D and 21 patients were in grade E according to ASIA scale. The perioperative data were recorded, which included preoperative Cobb angle, postoperative Cobb angle, final follow-up Cobb angle, apical vertebrae, the length difference of anterior column and posterior column, operation time, perioperative blood loss and complications. Results: The average operation time was 306.2±59.5mins. The average blood loss was 2046.2±742.4ml. Complications were noted in 5 patients. 2 cases were complicated with transient neurological deficits and 3 cases with cerebrospinal fluid(CSF) leak. The kyphosis Cobb angle decreased from 91.3°±17.5° to 17.1°±6.2°, with a correction rate of (80.9±6.6)%. The average time of follow-up was 30.8±16.5 months. The Cobb angle was 20.3°±6.1° and the loss of correction was 3% in the final follow-up. The anterior column increased by 3.6±3.1cm while posterior column shortened by 2.7±1.1cm. Among 5 patients with preoperative neurological deficit, one patient with ASIA C improved to ASIA D, 3 patients improved from ASIA D to ASIA E, one patient with ASIA D did not recover in the last follow-up. Conclusions: PVCD without using conventional titanium mesh is a safe and effective option for Pott′s deformity.