支撑棒技术在后路胸腰椎矫形融合术治疗伴严重冠状面失衡和骨盆倾斜脊柱侧凸中的临床应用

Clinical effect of kickstand rod in posterior throacolumbar orthopedic fusion surgery in treating patients with spinal scoliosis accompanied by severe coronal imbalance and pelvic obliquity

中文关键词:  脊柱侧凸  骨盆倾斜  冠状面失衡  支撑棒技术  骨盆固定

英文关键词:Scoliosis  Pelvic obliquity  Coronal imbalance  Kickstand rod  Pelvic fixation

中文摘要:

  【摘要】 目的：评价应用支撑棒（kickstand rod，KR）技术的后路胸腰椎矫形融合术治疗伴有严重冠状面失衡（coronal imbalance，CI）和骨盆倾斜（pelvic obliquity，PO）脊柱侧凸患者的矫正效果及其并发症。方法：回顾性分析2019年1月~2020年12月在我院接受后路胸腰椎矫形融合术（脊柱-骨盆融合手术）治疗的45例伴严重CI和PO的脊柱侧凸的患者资料。男性6例，女性39例，年龄51.2±17.5岁（12~73岁），随访时间16.4±5.3个月（11~26个月）。按骨盆固定的方式将使用经S2骶髂螺钉（S2 alar-iliac，S2AI）而未应用支撑棒技术行骨盆固定的患者纳入非KR组（25例），将使用支撑棒内固定技术行骨盆固定的患者纳入KR组（20例）。术前、术后7d和末次随访时在全脊柱正侧位X线片测量冠状面平衡距离（coronal balance distance，CBD）、骨盆倾斜角（pelvic obliquity angle，POA）、侧凸Cobb角、腰骶半弯（lumbosacral fractional curve，LFC）和骨盆入射角（pelvic incidence，PI），比较两组患者脊柱骨盆参数矫正率以及末次随访时的矫正丢失率，记录患者术后及随访期间的并发症发生情况。结果：两组患者术前的侧凸Cobb角、POA、CBD、LFC和PI均无统计学差异（P＞0.05）。两组患者侧凸Cobb角、POA、CBD、LFC术后7d时与术前相比均有明显改善（P＜0.05），KR组患者末次随访时与术后7d相比无统计学差异（P＞0.05），非KR组患者在末次随访时POA出现明显矫正丢失（P＜0.05）。KR组和非KR组患者术后POA的矫正率分别为（66.9±13.4）%和（44.2±23.4）%，CBD的矫正率分别为（58.5±20.9）%和（42.9±20.9）%，有统计学差异（P＜0.05）；其余影像学参数在两组患者间均无统计学差异（P＞0.05）。随访期间KR组1例发生断棒，非KR组3例发生术后CI，两组并发症发生率的差异无统计学意义（χ2=0.672，P=0.412）。结论：对于合并严重CI和PO的脊柱侧凸患者，与传统骨盆固定方式相比，应用KR技术的后路矫形脊柱-骨盆融合手术可以在矫正脊柱侧凸的同时维持良好的骨盆水平和冠状面平衡。

英文摘要:

  【Abstract】 Objectives: To evaluate the correction of kickstand rod(KR) in posterior thoracolumbar fusion surgery for the treatment of scoliosis patients with severe coronal imbalance(CI) and pelvic obliquity(PO). Methods: From January 2019 to December 2020, a consecutive cohort of 45 scoliosis patients with CI and PO undergoing posterior thoracolumbar(spino-pelvic) fusion in our hospital were retrospectively analyzed, including 6 males and 39 females, aged 51.2±17.5(12-73) years, and followed up for 16.4±5.3 months(11-26 months). According to pelvic fixation method, the patients were divided into KR group of 20 cases fixed with KR technique and non-KR group of 25 cases fixed with S2 alar-iliac(S2AI) screw and iliac sacral screw(ISS). On the full spine anteroposterior and lateral radiographs before operation, at postoperative 7d and final follow-up, the coronal balance distance(CBD), pelvic obliquity angle(POA), coronal Cobb angle, lumbosacral fractional curve(LFC), and pelvic incidence(PI) were measured. The correction rates of spinopelvic parameters and the correction loss rates at the final follow-up were compared between the two groups. The complications after operation and during follow-up were collected. Results: The Cobb angle, POA, CBD, LFC and PI before operation were not statistically different from each other between the two groups(P>0.05), and those at postoperative 7d of both groups were statistically different from those before operation(P<0.05). In KR group, the Cobb angle, POA, CBD, LFC, and PI at final follow-up were not significantly different from those at postoperative 7d(P>0.05). In non-KR group, while the POA at final follow-up significantly decreased from that at postoperative 7d(P<0.05). The correction rates of POA and CBD in KR group and non-KR group were(66.9±13.4)% vs (44.2±23.4)% and (58.5±20.9)% vs (42.9±20.9)% respectively(P＜0.05). The differences of other imaging parameters between the two groups were not with statistical significance(P>0.05). During follow-up period, 1 patient in KR group developed rod breakage and 3 patients in non-KR group developed CI. The incidence of complications did not show any statistical difference between the two groups(χ2=0.672, P=0.412). Conclusions: Compared with traditional spino-pelvic fixation technique, KR based posterior spino-pelvic fusion surgery could achieve comparable correction and maintain coronal balance and pelvic level in scoliosis patients combined with severe coronal imbalance and pelvic obliquity.