合并椎体或椎管内异常对后路矫形手术治疗伴先天性关节挛缩症脊柱侧凸疗效的影响

Effect of vertebral or intraspinal abnormalities on the efficacy of posterior correction surgery for scoliosis with arthrogryposis multiplex congenita

中文关键词:  脊柱侧凸  先天性关节挛缩症  分节不良  脊髓拴系  矫形手术

英文关键词:Scoliosis  Arthrogryposis multiplex congenita  Poor segmentation  Tethered spinal cord  Orthopedic surgery

中文摘要:

  【摘要】 目的：分析椎体或椎管内异常对后路矫形手术治疗伴有先天性关节挛缩症（arthrogryposis multiplex congenita，AMC）脊柱侧凸患者效果的影响。方法：回顾性分析2001年8月～2021年11月于我院行后路矫形手术治疗的伴AMC脊柱侧凸的患者30例，其中男18例，女12例，年龄6～32（15.9±5.8）岁。根据是否伴有椎体或椎管内异常，将患者分为异常组（15例）和对照组（15例）。记录异常组患者椎体或椎管内异常的类型，比较两组患者融合节段个数、手术时间及术中出血量，记录随访过程中的并发症。结合仰卧位Bending片计算两组患者主弯柔韧度，于术前、术后2周及术后2年的立位全脊柱正侧位X线片上测量主弯侧凸Cobb角、冠状面平衡（C7PL-CSVL）、矢状面平衡（SVA）、胸椎后凸角（TK）和腰椎前凸角（LL），计算术后2周及末次随访的主弯矫正率。结果：在异常组中单纯分节不良10例（66.6%），分节不良合并脊髓拴系2例（13.3%），分节不良合并蛛网膜囊肿、单纯半椎体、单纯楔形椎各1例（6.7%）。两组间融合节段个数、手术时间及术中出血量均无统计学差异（P＞0.05）。异常组术中未发生并发症，术后发现椎弓根螺钉位置不良2例，胸腔积液及右侧臂丛神经麻痹1例；对照组术中出现恶性高热及心搏骤停1例，术后发现椎弓根螺钉位置不良3例，胸腔积液及置钉失败1例，两组并发症发生率无统计学差异（P=0.628）。两组患者术前主弯柔韧度无统计学差异（P＞0.05）；术前、术后2周及术后2年时的主弯侧凸Cobb、C7PL-CSVL、SVA、TK及LL均无统计学差异（P＞0.05）；术后2周和术后2年的主弯矫正率亦无统计学差异（P＞0.05）。结论：椎体或椎管内异常对后路矫形手术治疗伴AMC脊柱侧凸患者效果无明显影响，且术中和术后并发症发生率无明显差异。

英文摘要:

  【Abstract】 Objectives: To analyze the effect of vertebral or intraspinal abnormalities on the efficacy of posterior corrective surgery for scoliosis patients with arthrogryposis multiplex congenita(AMC). Methods: A retrospective study was conducted on 30 scoliosis patients with AMC who underwent posterior corrective surgery in the Department of Spine Surgery of Drum Tower Hospital between August 2001 and November 2021. There were 18 males and 12 females with a mean age of 15.9±5.8(6-32) years. The patients were divided into abnormal group(15 cases) and control group(15 cases) according to with or without vertebral or intraspinal abnormalities. The types of vertebral or intraspinal abnormalities in the abnormal group were recorded, and the number of fusion segments, operative time and intraoperative blood loss were compared between groups. The complications during follow-up were also collected. The flexibility of major curve was assessed on Bending radiographs, and the main curve Cobb angle, the distance between C7 plumb line and center sacral vertical line(C7PL-CSVL), the sagittal vertical axis(SVA), the thoracic kyphosis(TK), and the lumbar lordosis(LL) were measured on the standing whole spine anteroposterior and lateral X-ray images at pre-operation, postoperative two weeks and two years, and the correction rate of major curve was calculated at 2 weeks after surgery and the final follow-up. Results: There were 10 cases of simple poor segmentation(66.6%), 2 cases of poor segmentation combined with tethered cord(13.3%), and 1 case of poor segmentation combined with arachnoid cyst, simple hemivertebra, and simple wedge-shaped vertebra(6.7%) each in the abnormal group. There were no significant differences between abnormal group and control group in the number of fusion segments, operative time and intraoperative blood loss(P>0.05). No complication was observed during operation in the abnormal group, and 3 complications were observed during follow-up, including 2 cases with screw misplacements and 1 case with thoracic effusion and the right brachial plexus paralysis; 5 cases of complications in the control group were observed, including 1 case with malignant hyperthermia and cardiac arrest during the surgery, 3 cases with screw misplacements and 1 with thoracic effusion and screw placement failure. The incidence of complications was not statistically different between the two groups(P=0.628). The flexibility of major curve before operation was not statistically different between the two groups(P>0.05); The major curve Cobb angle, C7PL-CSVL, SVA, TK and LL at pre-operation, post-operative two weeks and 2 months were not statistically different between groups(P>0.05); The correction rate of major curve at 2 weeks and 2 months after surgery were not significantly different as well(P>0.05). Conclusions: Vertebral or intraspinal abnormalities have no obvious effects on the efficacy of posterior corrective surgery for the treatment of scoliosis patients with AMC, and there is no significant increase in the incidence of intraoperative and postoperative complications.