后路半椎体切除凹侧置入椎间融合器治疗先天性腰骶部半椎体畸形的疗效分析

Clinical efficacy of posterior hemivertebra resection and cage implantation on the concave side in treating congenital lumbosacral hemivertebra deformity

中文关键词:  半椎体畸形  脊柱侧凸  腰骶部  椎间融合器

英文关键词:Scoliosis  Lumbosacral region  Hemivertebra deformity  Cage

中文摘要:

  【摘要】　目的：探讨后路半椎体切除凹侧置入椎间融合器治疗先天性腰骶部半椎体畸形的临床及影像学效果。方法：回顾性分析2010年1月~2019年12月在我院接受手术治疗的42例先天性腰骶部半椎体畸形患者的临床资料，其中16例采用后路半椎体切除凹侧置入椎间融合器，男4例，女12例，年龄16.82±6.54岁，纳入融合器组；26例单纯采用后路半椎体切除术，经倾向评分匹配法校正混杂因素后，与融合器组进行1∶1匹配出16例患者，男7例，女9例，年龄14.13±5.71岁，纳入非融合器组。比较两组患者手术时间、失血量、内置物失败情况及术前、术后和末次随访时的影像学参数（Risser征、腰骶侧凸角、胸腰段/腰段侧凸Cobb角、冠状面平衡、骨盆倾斜角、骨盆入射角、骶骨倾斜角、腰椎前凸角、下腰椎前凸角、矢状面垂直轴），术前和末次随访时采用脊柱侧凸研究学会-22（Scoliosis Research Society-22，SRS-22）问卷量表评估患者健康相关生活质量（health-related quality of Life，HRQoL）。结果：两组患者均顺利完成手术，手术时间（174.20±73.53min vs 201.62±93.84min）和术中出血量（325.76±92.26mL vs 374.63±123.79mL）均无统计学差异（P>0.05）。两组患者术前Risser征、腰骶侧凸角度及胸腰段/腰段侧凸角度、冠状面平衡、骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸角、矢状面垂直轴均无统计学差异（P>0.05）。术后和末次随访时的腰骶侧凸角度及胸腰段/腰段侧凸角度、骨盆入射角、骨盆倾斜角较术前显著性改善（P<0.001）；融合器组末次随访时腰骶侧凸矫正效果更优，侧凸程度显著性低于非融合器组；融合器组腰骶侧凸及胸腰段/腰段侧凸的矫正率均显著性高于非融合器组（P<0.05）。末次随访时两组下腰椎前凸角度均较术前显著性改善（P<0.05），融合器组的下腰椎前凸角度及其矫正幅度均显著性优于非融合器组（P<0.05），且无内固定失败。两组SRS-22评分总分较术前均显著性改善（P<0.05），两组间无显著性差异（P>0.05）。结论：先天性腰骶部半椎体畸形患者在后路半椎体切除术基础上于凹侧置入椎间融合器进行后柱重建，可显著提高腰骶部畸形冠状面矫正率及腰椎前凸角度，更有利于恢复脊柱冠矢状面平衡。

英文摘要:

  【Abstract】　Objectives: To explore the clinical and radiological effects of cage implantation on the concave side after hemivertebra resection for the treatment of congenital lumbosacral hemivertebra deformity. Methods: The clinical data of 42 patients with congenital lumbosacral hemivertebra deformity who underwent surgical treatment at our hospital between January 2021 and December 2019 were analyzed retrospectively. Among the patients, 16 received posterior hemivertebra resection and cage implantation on the concave side were included into the cage group(4 males, 12 females, aged 16.82±6.54 years) and 16 patients(7 males and 9 females, aged 14.13±5.71 years) matched 1∶1 with the cage group after correcting for confounding factors by propensity score matching method from the left 26 patients who received single posterior hemivertebrectomy were included into a non-cage group. The operative time, blood loss, implant failure were compared between groups, as well as imaging parameters[Risser sign, lumbosacral scoliosis angle, thoracolumbar/lumbar scoliosis Cobb angle, coronal balance, pelvic tilt, pelvic incidence, sacral inclination, lumbar lordosis, lower lumbar lordosis, sagittal vertical axis] before, after operation, and at final follow-up. The Scoliosis Research Society-22(SRS-22) questionnaire scale was used to evaluate the health-related quality of Life(HRQoL) of the patients before operation and at final follow-up. Results: Both groups of patients successfully completed the operation. No statistically significant differences were observed between the two groups in operative time(174.20±73.53min vs 201.62±93.84min) or intraoperative blood loss(325.76±92.26mL vs 374.63±123.79mL)(P>0.05). There was no statistical significance between the two groups in the Risser sign, lumbosacral scoliosis, thoracolumbar/lumbar scoliosis, coronal balance, pelvic tilt, pelvic incidence, sacral inclination, lumbar lordosis, or sagittal vertical axis before operation(P>0.05). At final follow-up, the degrees of lumbosacral scoliosis and thoracolumbar/lumbar scoliosis in both groups were significantly improved compared with those before surgery(P<0.001). The cage group had better correction effect of lumbosacral scoliosis, with a significantly lower degree of scoliosis at the final follow-up than the non-cage group; The correction rates of lumbosacral scoliosis and thoracolumbar/lumbar scoliosis in the cage group were significantly higher than those in the non-cage group(P<0.05). In terms of sagittal balance, the lower lumbar lordosis angle in both groups was significantly improved at the final follow-up compared with that before surgery(P<0.05). The lower lumbar lordosis angle and its correction amplitude in the cage group were significantly better than those in the non-cage group(P<0.05), and no internal fixation failure in the cage group. Conclusions: For patients with congenital lumbosacral hemivertebra deformity, posterior column reconstruction by implanting an cage on the concave side based on posterior hemivertebra resection can significantly improve the coronal correction rate of lumbosacral deformity and lumbar lordosis angle, which is more conducive to restoring the coronal and sagittal balance of the spine.