脊柱三柱分步截骨术在脊柱侧凸矫形手术中的应用

Application of staged three-column osteotomy in the surgical correction of scoliosis

中文关键词:  脊柱侧凸  截骨术  神经损伤  并发症

英文关键词:Scoliosis  Osteotomy  Neurologic injury  Complication

中文摘要:

  【摘要】 目的：探讨脊柱三柱分步截骨术（staged three-column osteotomy，S-3CO）在脊柱侧凸矫形手术中的有效性及安全性。方法：回顾性分析2015年1月~2022年12月在我院行S-3CO手术治疗的18例脊柱侧凸患者的临床资料（S-3CO组），其中男性7例，女性11例，年龄11.8±7.7岁，随访37.5±12.4个月。收集并分析患者影像学资料，包括术前及末次随访时主弯Cobb角、C7铅垂线与骶骨正中线的水平距离（C7-central sacral vertical line，C7-CSVL）、矢状面轴向距离（sagittal vertical axis，SVA）、截骨部位局部Cobb角（regional Cobb angle，RCA）、截骨部位局部后凸角（regional kyphosis angle，RKA），及并发症情况。收集同时段采用传统三柱截骨（three-column osteotomy，3CO）技术的15例同类患者资料（3CO组），两组患者性别、年龄、截骨级别和固定节段数比较差异无统计学意义（P>0.05）。统计并对比两组患者的手术时间及手术出血量。结果：S-3CO组术前主弯Cobb角为66.7°±23.9°，RCA为35.3°±6.7°，RKA为25.2°±14.2°；末次随访时，主弯Cobb角为25.7°±13.3°，RCA为17.6°±6.3°，RKA为12.6°±10.6°，差异均具有统计学意义（P<0.05）。术前C7-CSVL及SVA分别为27.9±14.5mm及29.0±8.7mm，末次随访时分别为12.7±5.5mm及17.4±5.6mm，差异均具有统计学意义（P<0.05）。S-3CO组共有3例患者术中出现神经监护报警，其中1例出现术后神经并发症，保守治疗后2年随访时右下肢肌力由2级恢复至4级。S-3CO组的手术时间显著低于3CO组（358.3±140.2min vs 416.3±121.2min，P<0.05），手术出血量显著低于3CO组（850.0±359.3mL vs 977.3±236.4mL，P<0.05）。结论：通过保留部分后柱结构连接的S-3CO可实现充分的局部矫形，从而提高脊柱侧凸的整体矫形效率。截骨过程中保留后方结构的连接与保护，可降低神经损伤的风险。

英文摘要:

  【Abstract】 Objectives: To investigate the efficacy and safety of staged three-column osteotomy(S-3CO) with posterior column connection preserved in the corrective surgery for scoliosis. Methods: The clinical data of 18 patients(7 males and 11 females, 11.8±7.7 years old, followed up for 37.5±12.4 months) with scoliosis treated with S-3CO in our hospital from January 2015 to December 2022 were retrospectively analyzed(S-3CO group). The Cobb angle of the main curve, the horizontal distance between C7 and central sacral vertical line(C7-CSVL) and the sagittal vertical axis(SVA), regional Cobb angle(RCA), regional kyphosis angle(RKA) of the patients in the S-3CO group were collected and compared before operation and at the final follow-up. The complications were analyzed. 15 patients with scoliosis who received the traditional three-column osteotomy(3CO) technique during the same period were analyzed(3CO group). There were no statistical difference between the two groups in age, gender, osteotomy grade, and number of fixed segments(P>0.05). The operative time and the blood loss volume were compared between the two groups. Results: The preoperative Cobb angle of the main curve was 66.7°±23.9°, RCA was 35.3°±6.7°, and RKA was 25.2°±14.2° of the patients in the S-3CO group. The final follow-up Cobb angle of the main curve was 25.7°±13.3°, RCA was 17.6°±6.3°, and RKA was 12.6°±10.6°. The differences in the values between the final follow-up and preoperation were significantly different(P<0.05). The preoperative C7-CSVL and SVA were 27.9±14.5mm and 29.0±8.7mm, respectively, and 12.7±5.5mm and 17.4±5.6mm respectively at the final follow-up, with statistical differences(P<0.05). A total of 3 patients in S-3CO group had neuromonitoring alarms during the operation, and 1 of whom had postoperative neurological complication, which was recovered from grade 2 to grade 4 in muscle strength of the right lower limb at 2 years follow-up after conservative treatment. The operative time of S-3CO group was significantly shorter than that of the 3CO group(358.3±140.2min vs 416.3±121.2min, P<0.05), and the blood loss volume was significantly less than that of the 3CO group(850.0±359.3mL vs 977.3±236.4mL, P<0.05). Conclusions: By preserving part of the posterior column connection, S-3CO can achieve sufficient local correction and improve the overall corrective efficiency of scoliosis. Preserving the connection and protection of the posterior structure during osteotomy reduces the risk of neurologic injury.