皮质骨螺钉加传统椎弓根螺钉结合卫星棒固定治疗退变性脊柱侧凸的疗效观察

Cortical bone trajectory and traditional trajectory combined with satellite rod fixation for degenerative scoliosis

中文关键词:  退变性脊柱侧凸  长节段固定  皮质骨螺钉  椎弓根螺钉  卫星棒

英文关键词:Degenerative scoliosis  Long segment fixation  Cortical bone trajectory  Traditional trajectory  Satellite rods

中文摘要:

  【摘要】 目的：观察皮质骨螺钉（cortical bone trajectory，CBT）加传统椎弓根螺钉（traditional trajectory，TT）结合卫星棒、远端固定至S1治疗成人退变性脊柱侧凸（adult degenerative scoliosis，ADS）的可行性及临床疗效。方法：回顾性分析2014年6月~2018年1月在我院采用长节段融合CBT+TT结合卫星棒、远端固定至S1矫形固定治疗的11例ADS患者的资料。比较患者术前和末次随访时的腰背痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI），术前、术后即刻和末次随访时的Cobb角、C7铅垂线（C7 plumb line，C7PL）与骶骨中垂线（center sacral vertical line，CSVL）的相对距离（C7PL-CSVL）和脊柱矢状轴（sagittal vertebral axis，SVA）。结果：11例患者均为女性，年龄51~73岁（64.36±7.63岁），手术时间247.64±44.96min，术中出血量1118.18±464.37ml。1例患者术后出现脑脊液漏，延长引流时间、换药后愈合；1例患者术后出现一过性肌力减退，给予口服甲钴胺2周，于术后3个月恢复，无其他严重并发症发生。术后随访13~60个月（33.87±14.36个月），术前VAS评分为7.00±0.89分，末次随访时为0.91±0.70分，差异有统计学意义（P＜0.05）；术前ODI为（51.09±7.83）%，末次随访时为（5.45±1.13）%，差异有统计学意义（P＜0.05）。术前、术后即刻、末次随访时冠状面Cobb角分别为49.10°±11.51°、12.05°±3.78°、13.06°±3.38°，C7PL-CSVL分别为27.27±17.61mm、12.20±8.04mm、12.40±8.05mm，SVA分别为25.33±18.21mm、8.60±5.31mm、9.75±6.94mm，末次随访时的Cobb角、C7PL-CSVL、SVA与术前比较均有统计学差异（P＜0.05）；末次随访时与术后即刻比较均无统计学差异（P＞0.05）。随访期内所有患者均未出现内固定失败征象。结论：CBT+TT结合卫星棒矫形远端固定至S1长节段腰骶融合可增强脊柱骨盆固定强度，治疗ADS可取得较好的临床疗效。

英文摘要:

  【Abstract】 Objectives: To explore the feasibility and clinical outcomes of cortical bone trajectory(CBT) and traditional trajectory(TT) combined with satellite rod which terminated to S1 in patients with adult degenerative scoliosis(ADS). Methods: This retrospective study included patients with ADS who underwent CBT+TT combining with satellite rods long fusion, from June 2014 to January 2018. Visual analogue score(VAS), the Oswestry disability index(ODI), Cobb angle, the distance between C7 plumb line and center sacral vertical line(C7PL-CSVL) and sagittal vertebral axis(SVA ) were compared among before operation, immediately after operation and at final follow-up. Results: A toal of 11 patients were enrolle, all of them were female with an average age of 64.36±7.63 years. The operation time was 247.64±44.96min, and the blood loss was 1118.18±464.37ml. Cerebrospinal fluid leakage occurred in 1 patient, and the wound healed well after prolonged drainage and dressing change. 1 patient showed transient muscle weakness after surgery, and was given mecobalamine for 2 weeks, who recovered three months after the operation. No serious complication occurred. The mean follow-up time was 33.87±14.36 months. VAS score was 7.00±0.89 points before surgery and 0.91±0.70 points at the last of follow-up. The ODI was (51.09±7.83)% at the initial examination and (5.45±1.13)% at the final follow-up. The Cobb angle decreased from 49.10°±11.51° preoperatively to 12.05°±3.78 immediately after operation and 13.06°±3.38 at the last of follow-up. C7PL-CSVL was 27.27±17.61mm, 12.20±8.04mm and 2.40±8.05mm preoperatively, immediately after operation and at the last follow-up respectively. SVA was 25.33±18.21mm, 8.60±5.31mm and 9.75±6.94mm preoperatively, immediately after operation and at the end follow-up respectively. There were significant differences of Cobb angle, C7PL-CSVL and SVA between before operation and at the final follow-up(P＜0.05), but there was no statistical significance difference of the above three measurements between immediately after operation and at the final follow-up(P＞0.05). All patients had no failure of instrument. Conclusions: CBT and TT combined with satellite rod which terminated to S1 has a good short and mid term outcomes in ADS, and provides a new reliable measure to enhance fixation of spine and pelvis.