一期三柱截骨术治疗先天性脊柱侧凸合并脊髓异常的临床研究

Clinical study of one-stage three-column osteotomy in treatment of congenital scoliosis combined with spinal cord deformity

中文关键词:  先天性脊柱侧凸  三柱截骨术  脊髓畸形  脊髓纵裂  脊髓空洞  脊髓拴系

英文关键词:Congenital scoliosis  Three-column osteotomy  Spinal cord deformity  Split cord malformation  Syringomyelia  Tethered spinal cord syndrome

中文摘要:

  【摘要】 目的：评价一期三柱截骨术治疗先天性脊柱侧凸合并脊髓异常患者的有效性及安全性。方法：以2015年1月~2017年5月我院收治的62例先天性脊柱侧凸合并脊髓异常患者为研究对象，男32例，女30例，年龄4~35岁，平均15.3±8.3岁；46例具有神经症状。所有患者均行一期三柱截骨矫形术，术后随访12个月。记录手术时间、术中出血量及术后并发症发生情况；在术前、术后3个月及末次随访时，采用脊柱裂神经量表（SBNS）对患者的估神经功能进行评估，采用视觉模拟评分（VAS）评价疼痛程度，对患者进行全脊柱正侧位Ｘ线检查，测量冠状位Cobb角、矢状位后凸Cobb角、躯干偏移，计算矫正率及丢失率。结果：手术平均时间与术中平均出血量分别为565.3±140.8min、3570.6±1855.4ml；术后3个月平均冠状位Cobb角为41.7°±17.7°，平均矫正率为（62.5±13.8）%；平均矢状位后凸Cobb角为38.5°±11.2°，平均矫正率为（66.4±22.6）%；末次随访时平均冠状位Cobb角为43.7°±16.6°，平均丢失率为（1.9±1.1）%；平均矢状位后凸Cobb角为39.7°±11.3°，平均丢失率为（2.3±1.4）%；术后3个月及末次随访时的Cobb角、躯干偏移、SBNS评分及VAS疼痛评分均得到明显改善（P<0.05）；术前28例SBNS分级为Ⅱ级的患者恢复至Ⅰ级，9例SBNS分级为Ⅲ级的患者恢复至Ⅱ级；14例腰骶部疼痛患者、9例下肢肌力下降患者、8例大小便功能障碍患者及4例下肢细小患者得到改善；发生术后并发症8例，包括3例脑脊液漏、2例伤口感染及3例泌尿系感染。结论：一期三柱截骨术治疗先天性脊柱侧凸合并脊髓异常患者安全有效，且能促进神经功能的恢复。

英文摘要:

  【Abstract】 Objectives: To evaluate the effectiveness and safety of one-stage three-column osteotomy in treatment of patients with congenital scoliosis combined with spinal cord deformity. Methods: 62 patients with congenital scoliosis combined with spinal cord deformity from January 2015 to May 2017 were studied. Including 32 male and 30 female patients, aged 15.3±8.3 years(7-35 years) and 46 patients with neurological symptoms. All patients underwent one-stage three-column osteotomy and were followed up for 12 months. The operative time, intraoperatve blood loss and postoperative complication was recorded. The neurological function was evaluated by spina bifida neurological scale(SBNS), the pain degree was evaluated by visual analogue scale(VAS), the coronal Cobb angle, sagittal posterior convex Cobb angle, trunk migration were measured by positive and lateral position Ｘ-ray of total spine, the correction rate and loss rate were calculated before operation, at 3 momths after operation and at final follow-up. Results: The operative average time, intraoperatve average blood loss was 565.3±140.8min, 3570.6±1855.4ml, respectively. At 3 momths after operation, the average coronal Cobb angle was 41.7°±17.7° and the average correction rate was (62.5±13.8)%, the average posterior convex Cobb angle was 38.5°±11.2° and the average correction rate was (66.4±22.6)%. At final follow-up, the average coronal Cobb angle was 43.7°±16.6° and the average loss rate was (1.9±1.1)%, the average posterior convex Cobb angle was 39.7°±11.3° and the average loss rate was(2.3±1.4)%. At 3 momths after operation and at final follow-up, the Cobb angle, trunk migration, SBNS score and VAS score was significantly improved(P<0.05). 28 patients were improved from preoperative SBNS grade Ⅱ to grade Ⅰ, 9 patients were improved from preoperative SBNS grade Ⅲ to grade Ⅱ. There were 14 patients with lumbosacral pain, 9 patients with lower limb muscle strength decreased, 8 patients with urination and defecation function disturbance, 4 patients with lower limbs tiny which was improved. There were 8 cases of postoperative complications including 3 patients with cerebrospinal fluid leak, 2 patients with wound infection and 3 patients with urinary system infection. Conclusions: One-stage three-column osteotomy was safe and effective in the treatment of patients with congenital scoliosis combined with spinal cord deformity and it could promote the recovery of neurological function.