后路脊柱去松质骨截骨治疗Pott′s角状后凸畸形的安全性及有效性
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摘要
目的:探讨不使用传统钛网支撑植骨的后路脊柱去松质骨截骨术(posterior vertebral column decancellation,PVCD)治疗Pott′s角状后凸畸形的安全性及有效性。方法 :回顾性分析2010年8月~2014年5月于我院行PVCD治疗且资料完整的26例Pott′s角状后凸畸形患者的临床资料,其中男11例,女15例,年龄24.8±7.6岁(14~46岁)。后凸顶点位于胸椎6例,胸腰段18例,腰椎2例。术前ASIA分级C级1例,D级4例,E级21例。记录并分析手术前后及末次随访时的后凸Cobb角、顶椎区域前柱和后柱长度变化、手术时间、术中出血量、手术并发症。结果:手术时间为306.2±59.5min(200~420min),术中出血量为2046.2±742.4ml(1000~4000ml)。5例患者围手术期出现并发症,其中一过性神经症状2例,脑脊液漏3例。术前后凸Cobb角为91.3°±17.5°(66°~140°),术后为17.1°±6.2°(4°~30°),矫正74.2°±18.1°,矫正率为(80.9±6.6)%。截骨部位前柱增加3.6±3.1cm(0~8.4cm),后柱短缩2.7±1.1cm(1.3~4.8cm)。所有患者均获随访,随访时间为30.8±16.5个月(12~60个月)。末次随访时后凸Cobb角为20.3°±6.1°(9°~33°),矫正平均丢失3%。末次随访ASIA分级C级患者恢复为D级,3例D级患者恢复为E级,1例D级患者无恢复。结论:不使用传统钛网支撑植骨的PVCD技术是治疗Pott′s后凸畸形的一种安全有效的方法。
Objectives: To explore the safety and effectiveness of bony cage rather than titanium mesh in posterior vertebral column decancellation(PVCD) in the management of Pott′s sharp kyphosis deformity. Methods: Prospective analysis of 26 patients with Pott′ s deformity underwent PVCD from August 2010 to May2014, with a minimun follow-up of 1 year and a maximun follow-up of 5 years. There were 11 males and15 females with an average age of 24.8±7.6 years old. Among them, the number of apical vertebrae located in thoracic region, thoracolumbar region and lumbar region was 6, 18 and 2, respectively. 1 patient was in grade C, 4 patients were in grade D and 21 patients were in grade E according to ASIA scale. The perioperative data were recorded, which included preoperative Cobb angle, postoperative Cobb angle, final follow-up Cobb angle, apical vertebrae, the length difference of anterior column and posterior column, operation time,perioperative blood loss and complications. Results: The average operation time was 306.2±59.5mins. The average blood loss was 2046.2 ±742.4ml. Complications were noted in 5 patients. 2 cases were complicated with transient neurological deficits and 3 cases with cerebrospinal fluid(CSF) leak. The kyphosis Cobb angle decreased from 91.3°±17.5° to 17.1°±6.2°, with a correction rate of(80.9±6.6)%. The average time of followup was 30.8±16.5 months. The Cobb angle was 20.3°±6.1° and the loss of correction was 3% in the final follow-up. The anterior column increased by 3.6±3.1cm while posterior column shortened by 2.7±1.1cm. Among 5 patients with preoperative neurological deficit, one patient with ASIA C improved to ASIA D, 3 patients improved from ASIA D to ASIA E, one patient with ASIA D did not recover in the last follow-up.Conclusions: PVCD without using conventional titanium mesh is a safe and effective option for Pott′s deformity.
Objectives: To explore the safety and effectiveness of bony cage rather than titanium mesh in posterior vertebral column decancellation(PVCD) in the management of Pott′s sharp kyphosis deformity. Methods: Prospective analysis of 26 patients with Pott′ s deformity underwent PVCD from August 2010 to May2014, with a minimun follow-up of 1 year and a maximun follow-up of 5 years. There were 11 males and15 females with an average age of 24.8±7.6 years old. Among them, the number of apical vertebrae located in thoracic region, thoracolumbar region and lumbar region was 6, 18 and 2, respectively. 1 patient was in grade C, 4 patients were in grade D and 21 patients were in grade E according to ASIA scale. The perioperative data were recorded, which included preoperative Cobb angle, postoperative Cobb angle, final follow-up Cobb angle, apical vertebrae, the length difference of anterior column and posterior column, operation time,perioperative blood loss and complications. Results: The average operation time was 306.2±59.5mins. The average blood loss was 2046.2 ±742.4ml. Complications were noted in 5 patients. 2 cases were complicated with transient neurological deficits and 3 cases with cerebrospinal fluid(CSF) leak. The kyphosis Cobb angle decreased from 91.3°±17.5° to 17.1°±6.2°, with a correction rate of(80.9±6.6)%. The average time of followup was 30.8±16.5 months. The Cobb angle was 20.3°±6.1° and the loss of correction was 3% in the final follow-up. The anterior column increased by 3.6±3.1cm while posterior column shortened by 2.7±1.1cm. Among 5 patients with preoperative neurological deficit, one patient with ASIA C improved to ASIA D, 3 patients improved from ASIA D to ASIA E, one patient with ASIA D did not recover in the last follow-up.Conclusions: PVCD without using conventional titanium mesh is a safe and effective option for Pott′s deformity.
引文
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9 .Suk SI,Kim JH,Kim WJ,et al.Posterior vertebral column resection for severe spinal deformities[J].Spine,2002,27(21):2374-2382.
10 .Lenke LG,O′Leary PT,Bridwell KH,et al.Posterior vertebral column resection for severe pediatric deformity:minimum two-year follow-up of thirty-five consecutive patients[J].Spine,2009,34(20):2213-2221.
11 .Lenke LG,Sides BA,Koester LA,et al.Vertebral column resection for the treatment of severe spinal deformity[J].Clin Orthop Relat Res,2010,468(3):687-699.
12 .Bradford DS,Tribus CB.Vertebral column resection for the treatment of rigid coronal decompensation[J].Spine,1997,22(14):1590-1599.
13 .王岩,张永刚,郑国权.脊柱去松质骨截骨治疗僵硬性脊柱侧凸的有效性及安全性分析[J].中华外科杂志,2010,48(22):1701-1704.
14 .Wang YS,Xie JM,Zhao Z,et al.Perioperative major nonneurological complications in 105 patients undergoing posterior vertebral column resection procedures for severe rigid deformities[J].Spine,2015,40(16):1289-1296.
15 .Lv G,Wang B,Li Y,et al.Posterior vertebral column resection and intraoperative manual traction to correct severe post-tubercular rigid spinal deformities incurred during childhood:minimum 2-year follow-up[J].Eur Spine J,2015,24(3):586-593.
16 .Auerbach JD,Lenke LG,Bridwell KH,et al.Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures[J].Spine,2012,37(14):1198-1210.
2 .Tuli SM.Severe kyphotic deformity in tuberculosis of the spine:current concepts[J].Int Orthop,1995,19(5):327-331.
3 .Chen IH,Chien JT,Yu TC.Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis:experience with 78 patients[J].Spine,2001,26(16):E354-360.
4 .Bridwell KH.Decision making regarding Smith-Petersen vs.pedicle subtraction osteotomy vs.vertebral column resection for spinal deformity[J].Spine,2006,31(19 Suppl):S171-178.
5 .Wang Y,Zhang YG,Zhang XS,et al.Posterior-only multilevel modified vertebral column resection for extremely severe Pott′s kyphotic deformity[J].Eur Spine J,2009,18(10):1436-1441.
6 .Moon MS.Tuberculosis of the spine,controversies and a new challenge[J].Spine,1997,22(15):1791-1797.
7 .Rajasekaran S.Natural history of Pott′s kyphosis[J].Eur Spine J,2013,22(Suppl 4):S634-640.
8 .Kawahara N,Tomita K,Kobayashi T,et al.Influence of acute shortening on the spinal cord:an experimental study[J].Spine,2005,30(6):613-620.
9 .Suk SI,Kim JH,Kim WJ,et al.Posterior vertebral column resection for severe spinal deformities[J].Spine,2002,27(21):2374-2382.
10 .Lenke LG,O′Leary PT,Bridwell KH,et al.Posterior vertebral column resection for severe pediatric deformity:minimum two-year follow-up of thirty-five consecutive patients[J].Spine,2009,34(20):2213-2221.
11 .Lenke LG,Sides BA,Koester LA,et al.Vertebral column resection for the treatment of severe spinal deformity[J].Clin Orthop Relat Res,2010,468(3):687-699.
12 .Bradford DS,Tribus CB.Vertebral column resection for the treatment of rigid coronal decompensation[J].Spine,1997,22(14):1590-1599.
13 .王岩,张永刚,郑国权.脊柱去松质骨截骨治疗僵硬性脊柱侧凸的有效性及安全性分析[J].中华外科杂志,2010,48(22):1701-1704.
14 .Wang YS,Xie JM,Zhao Z,et al.Perioperative major nonneurological complications in 105 patients undergoing posterior vertebral column resection procedures for severe rigid deformities[J].Spine,2015,40(16):1289-1296.
15 .Lv G,Wang B,Li Y,et al.Posterior vertebral column resection and intraoperative manual traction to correct severe post-tubercular rigid spinal deformities incurred during childhood:minimum 2-year follow-up[J].Eur Spine J,2015,24(3):586-593.
16 .Auerbach JD,Lenke LG,Bridwell KH,et al.Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures[J].Spine,2012,37(14):1198-1210.