| 童国军,蔡兵兵,全仁夫,李伟.重度先天性脊柱畸形一期头盆环牵引二期截骨矫形手术效果评价[J].浙江中西医结合杂志,2023,33(12): |
| 重度先天性脊柱畸形一期头盆环牵引二期截骨矫形手术效果评价 |
| Evaluation of the clinical effect of one-stage halo pelvic traction two-stage osteotomy surgery for severe congenital spinal deformitiesTong Guojun, Cai Bingbing, Quan Renfu,Li Wei |
| 投稿时间：2022-11-13 修订日期：2023-08-21 |
| DOI： |
| 中文关键词: 重度先天性脊柱畸形 头盆环牵引 截骨矫形 |
| 英文关键词:severe congenital spinal deformities halo pelvic traction Osteotomy |
| 基金项目: |
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| 中文摘要: |
| 目的 回顾分析20例重度先天性脊柱畸形患者采用一期头盆环牵引二期截骨矫形手术治疗患者的临床资料,探讨二期手术治疗重度先天性脊柱畸形的手术方法可行性及临床效果。方法 2018年10月～2021年10月,通过一期头盆环牵引二期截骨矫形治疗20例重度先天性脊柱畸形患者,男性13例,女性7例,年龄(23.2±7.03)岁(12～34岁),分别测量术前、头盆环牵引后及截骨术后的身高、后凸Cobb角、侧弯Cobb角、矫正率、矢状位及冠状位平衡参数,并比较各指标术前术后的变化情况。结果 20例患者术前、牵引后、截骨术后的身高分别为(134.95±12.75)cm(113～160cm)、(154.6±12.85)cm(131～177cm)、(156.9±13.01)cm(132～179cm), 与术前相比牵引后及截骨术后的身高差异有统计学意义(P<0.05)。术前、牵引后、截骨术后的脊柱后凸Cobb角分别为 (141.35±13.26)°(121～169°)、(92.8±6.24)°(77～103°)、(43.45±10.83)°(22～66°),与术前相比牵引后及截骨术后的后凸Cobb角差异有统计学意义(P<0.05),牵引后后凸矫正率(33.87±7.02)%,截骨术后后凸矫正率(69.3±7.12)%。术前、牵引后、截骨术后脊柱侧弯Cobb角分别为(126.4±14.34)°(109～142°)、(82.05±7.69)°(72～101°)、(37.05±9.9)°(18～53°),与术前相比牵引后及截骨术后的侧弯Cobb角差异有统计学意义 (P<0.05),牵引后侧弯矫正率(34.38±9.31)%,截骨术后侧弯矫正率(70.28±8.75)%。术前、牵引后、截骨术后冠状面平衡CVA分别为(20.86±3.63)mm(12.93～27.03mm)、(12.48±1.73)mm(9.97～15.87mm)、(10.15±2.11)mm(6.56～14.99mm),与术前相比牵引后及截骨术后的CVA差异有统计学意义结果(P<0.05)。术前、牵引后、截骨术后矢状面平衡SVA分别为(47.93±12.46)mm(29.72～68.14mm)、(16.66±4.47)mm(10.07～28.14mm)、(10.95±5.73)mm(3.59～29.34mm),与术前相比牵引后及截骨术后的SVA差异有统计学意义结果(P<0.05)。手术并发症包括一期牵引术后钉道感染3例,二期截骨术后胸腔积液4例,脑脊液漏2例,处理后均恢复良好,无明显神经并发症发生。结论 采用一期头盆环牵引二期截骨矫形可以降低手术风险,提高矫形效果,改善脊柱形态。 |
| 英文摘要: |
| Objective To review and analyze the clinical data of 20 patients with severe congenital spinal deformity treated by one-stage halo pelvic traction and two-stage osteotomy surgery, and to explore the feasibility and clinical effect of two-stage surgery for severe congenital spinal deformity. Methods From October 2018 to October 2021, 20 patients with severe congenital spinal deformity (13 males and 7 females, aged (23.2±7.03) years (12-34 years) were treated with one-stage halo pelvic traction and two-stage osteotomy surgery. Height, kyphotic Cobb Angle, scoliosis Cobb Angle, deformity correction rate, sagittal position and coronal position balance parameters were measured before surgery, after halo pelvis traction and after osteotomy surgery, and the changes of each index before and after surgery were compared. Results The height of 20 patients before surgery, after traction and after osteotomy were (134.95±12.75)cm(113-160cm), (154.6±12.85)cm(131-177cm) and (156.9±13.01)cm(132-179cm), respectively. The height difference after traction and osteotomy was statistically significant compared with that before surgery (P<0.05). The Cobb angles of kyphosis before surgery, after traction and after osteotomy were (141.35±13.26)°(121-169°), (92.8±6.24)°(77-103°), (43.45±10.83)°(22-66°), respectively. The Cobb Angle of kyphosis after traction and osteotomy was significantly different from that before and after osteotomy (P<0.05). The kyphosis correction rate after traction and osteotomy was (33.87±7.02)% and (69.3±7.12)% respectively. The Cobb angles of scoliosis before surgery, after traction and after osteotomy were (126.4±14.34)°(109-142), (82.05±7.69)°(72-101), (37.05±9.9)°(18-53), respectively. The Cobb Angle of scoliosis after traction and osteotomy was significantly different from that before surgery (P<0.05), the correction rate of scoliosis after traction was (34.38±9.31)%, and the correction rate of scoliosis after osteotomy was (70.28±8.75)%. The coronal vertical axis CVA before surgery, after traction and after osteotomy were (20.86±3.63)mm(12.93-27.03mm), (12.48±1.73)mm(9.97-15.87mm), (10.15±2.11)mm(6.56-14.99mm), respectively. Compared with the preoperative results, the CVA after traction and osteotomy was significantly different (P<0.05). The sagittal vertical axis SVA before surgery, after traction and after osteotomy were (47.93±12.46)mm(29.72-68.14mm), (16.66±4.47)mm(10.07-28.14mm), (10.95±5.73)mm(3.59-29.34mm), respectively. Compared with preoperative SVA after traction and osteotomy, there were statistically significant differences (P<0.05). The surgical complications included 3 cases pin-track infection after one-stage halo pelvic traction, 4 cases of pleural effusion after second-stage osteotomy, and 2 cases of cerebrospinal fluid leakage, all of which recovered well after treatment and no obvious neurological complications occurred. Conclusion The application of one-stage halo pelvic traction with two-stage osteotomy can reduce the risk of surgery, improve the effect of orthopedics, improve the appearance of the spine. |
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