颈椎牵引预矫形结合手术矫形治疗重度颈椎后凸畸形
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摘要
目的 :研究颈椎牵引预矫形结合手术矫形与单纯手术矫形治疗重度颈椎后凸畸形的疗效,探讨重度颈椎后凸畸形的治疗策略。方法:回顾性分析2003年3月~2017年3月,在我院接受手术治疗的大于40°的重度颈椎后凸畸形患者共32例,男24例,女8例。年龄5.9~63.4岁,平均19.5±12.2岁。根据治疗方案是否行牵引预矫形分为牵引组及非牵引组。牵引组26例,其中4例为颅骨牵引,22例为颈椎平衡悬吊牵引,6例先行颈椎松解手术、而后采用牵引预矫形,最后进行颈椎矫形内固定融合手术。非牵引组6例,单纯采用颈椎矫形内固定融合手术。测量及记录所有患者治疗前、矫形手术(前路、后路或前后联合入路矫形融合内固定手术)后出院前(术后2周左右)、末次随访时,以及牵引组患者牵引后(矫形手术前)不同时间点的颈椎后凸节段的后凸角、JOA脊髓功能评分并进行比较。结果 :本组32例后凸角由治疗前73.5°±26.5°矫正至术后16.6°±17.2°,最终矫正率平均(79.8±19.0)%,术后与治疗前存在统计学差异(P<0.05)。治疗前JOA评分11.9±4.5分,术后JOA评分15.2±2.9分,有统计学差异(P<0.05)。治疗前牵引组的后凸角(77.9°±26.5°)明显大于非牵引组(54.7°±18.2°,P<0.05),但是牵引组的手术矫正率(81.7±17.9)%高于非牵引组(73.4±25.8)%,存在统计学差异(P<0.05)。采用平衡悬吊牵引的牵引预矫正率(70.3±18.7)%及手术后的最终矫正率(83.8±14.4)%与采用颅骨牵引的相应指标(52.2±21.8)%、(70.4±32.1)%相比,差异无统计学意义(P>0.05)。结论 :对于重度颈椎后凸畸形,采用颈椎牵引预矫形,结合前路、后路或者前后联合入路矫形固定融合手术,可以取得良好的矫形效果。
Objectives: To investigate the efficacy and significance of pre-correction with cervical spine trac-tion in the treatment of severe cervical spine kyphosis by using retrospective analysis of surgical results.Methods: Retrospective study of patients with severe cervical spine kyphosis(Cobb>40°) who were treated in our hospital from March 2003 to March 2017. In this series, 32 cases with 24 males and 8 females, who were 19.5±12.2 years old on the average(5.9-63.4 years), were included. According to the use of cervical spine traction prior to correction surgery, the cases were divided into traction group and no traction group.There were 26 cases in traction group. In those, 4 cases underwent skull traction and 22 cases had cervical spine suspended traction before final surgical correction. Six cases had surgical releasementprior to traction.There were 6 cases in the notraction group. The cervical kyphosis angle and JOA(Japanese Orthopedic Asso-ciation) score were recorded at the admission, post-traction, discharge and follow-up. Results: In this series,the average kyphotic Cobb angle was 73.5°±26.5° and 16.6°±17.2°(P<0.05) before and after surgical correction, respectively. The final correction rate was(79.8 ±19.0)%. The JOA score improved from 11.9±4.5 to15.2±2.9(P<0.05). The kyphotic Cobb angle in traction group(77.9°±26.5°) was much worse than that in no traction group(54.7° ±18.2°, P <0.05) before the treatment. But the final surgical correction in traction group(81.7±17.9)% was better than that in no traction group(73.4±25.8)%. The pre-correction rate of(70.3±18.7)%and final surgical correction rate of(83.8±14.4)% in patients with suspended traction were higher than those of(52.2 ±21.8)% and(70.4 ±32.1)% with skull traction, nonetheless, the difference was not statistically significant. Conclusions: The pre-correction by cervical spine traction and final surgical correction by anterior,posterior or combined approaches of internal fixation and fusion can achieve good results for severe cervical spine kyphosis.
Objectives: To investigate the efficacy and significance of pre-correction with cervical spine trac-tion in the treatment of severe cervical spine kyphosis by using retrospective analysis of surgical results.Methods: Retrospective study of patients with severe cervical spine kyphosis(Cobb>40°) who were treated in our hospital from March 2003 to March 2017. In this series, 32 cases with 24 males and 8 females, who were 19.5±12.2 years old on the average(5.9-63.4 years), were included. According to the use of cervical spine traction prior to correction surgery, the cases were divided into traction group and no traction group.There were 26 cases in traction group. In those, 4 cases underwent skull traction and 22 cases had cervical spine suspended traction before final surgical correction. Six cases had surgical releasementprior to traction.There were 6 cases in the notraction group. The cervical kyphosis angle and JOA(Japanese Orthopedic Asso-ciation) score were recorded at the admission, post-traction, discharge and follow-up. Results: In this series,the average kyphotic Cobb angle was 73.5°±26.5° and 16.6°±17.2°(P<0.05) before and after surgical correction, respectively. The final correction rate was(79.8 ±19.0)%. The JOA score improved from 11.9±4.5 to15.2±2.9(P<0.05). The kyphotic Cobb angle in traction group(77.9°±26.5°) was much worse than that in no traction group(54.7° ±18.2°, P <0.05) before the treatment. But the final surgical correction in traction group(81.7±17.9)% was better than that in no traction group(73.4±25.8)%. The pre-correction rate of(70.3±18.7)%and final surgical correction rate of(83.8±14.4)% in patients with suspended traction were higher than those of(52.2 ±21.8)% and(70.4 ±32.1)% with skull traction, nonetheless, the difference was not statistically significant. Conclusions: The pre-correction by cervical spine traction and final surgical correction by anterior,posterior or combined approaches of internal fixation and fusion can achieve good results for severe cervical spine kyphosis.
引文
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9 .张立,孙宇,李锋,等.悬吊牵引预矫形手术融合内固定治疗青少年颈椎严重角状后凸畸形[J].中国脊柱脊髓杂志,2008,18(3):206-211.
10 .Wu F,Zhang L,Liu Z,et al.Cervical neurofibromatosis with tetraplegia:management by cervical suspensory traction[J].Spine(Phila Pa 1976),2012,37(14):E858-862.
2 .钟沃权,姜亮,孙宇,等.单纯前路与前后联合入路矫形手术治疗重度颈椎后凸畸形[J].中国脊柱脊髓杂志,2012,22(3):235-240.
3 .Zhang H,Liu S,Guo C,et al.Posterior surgery assisted by halo ring traction for the treatment of severe rigid nonangular cervical kyphosis[J].Orthopedics,2010,33(4):241-246.
4 .Kawabata S,Watanabe K,Hosogane N,et al.Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1[J].J Neurosurg Spine,2013,18(3):274-279.
5 .周许辉,张咏,方加虎,等.重度青少年特发性颈椎后凸畸形的手术治疗[J].中华外科杂志,2010,48(4):276-279.
6 .张宏其,袁丹,刘少华,等.重度僵硬型非角状颈椎后凸畸形的手术治疗[J].中国脊柱脊髓杂志,2008,18(4):266-269.
7 .Helenius IJ,Sponseller PD,Mackenzie W,et al.Outcomes of spinal fusion for cervical kyphosis in children with neurofibromatosis[J].J Bone Joint Surg Am,2016,98(21):e95.
8 .Goffin J,Grob D.Spondyloptosis of the cervical spine in neurofibromatosis:a case report[J].Spine,1999,24(6):587-590.
9 .张立,孙宇,李锋,等.悬吊牵引预矫形手术融合内固定治疗青少年颈椎严重角状后凸畸形[J].中国脊柱脊髓杂志,2008,18(3):206-211.
10 .Wu F,Zhang L,Liu Z,et al.Cervical neurofibromatosis with tetraplegia:management by cervical suspensory traction[J].Spine(Phila Pa 1976),2012,37(14):E858-862.