非顶椎截骨矫正陈旧性脊柱结核角状后凸

Non- apex vertebral osteotomy for correction of angular kyphosis of old thoracolumbar tuberculosis

摘要:

[目的]介绍非顶椎截骨矫正陈旧性脊柱结核角状后凸的手术技术和初步临床效果。[方法]对 14 例陈旧性脊柱结核性角状后凸的患者采用非顶椎截骨进行矫正手术治疗。后路充分暴露固定节段，顶椎近侧放置 4 对椎弓钉，远侧放置 3 对椎弓钉，安装双侧棒临时固定。选择顶椎下方邻近解剖结构相对正常的椎体进行全椎体截骨，交替调整双侧钉-棒，配合体位调整，逐渐矫正畸形。锁定钉-棒系统，后侧植骨融合。[结果]14 例患者均顺利完成了手术，手术时间平均（9.8±2.3）h，术中出血量平均（2 150.0±937.9）ml。1 例患者术后出现自截骨平面以下的截瘫，术后 1 年随访肛周及双下肢感觉及运功功能无明显恢复。所有患者均获随访 12 月以上，与术前相比，末次随访时 VAS 评分显著减少 [(3.1±1.1), (1.5±0.5), P＜0.001]；ODI 功能障碍指数无显著变化 [(9.7±1.7), (9.9±4.6), P＞0.05]。影像方面，与术前相比，术后 1 个月矢状面 Cobb 角 [(151.1±28.7)°, (19.7±5.2)°, P＜ 0.001]、矢状面偏移 [(28.9±11.6) mm, (3.9±2.8) mm, P＜0.001]、骶骨倾斜角 [(14.1±5.3)°, (22.3±5.6)°, P＜0.001]、骨盆倾斜角 [(23.9± 7.2)°, (13.8±5.0)°, P＜0.001] 均显著改善，但骨盆指数无显著变化 [(37.6±7.9)°, (35.4±8.1)°, P＞0.05]。[结论]非顶椎截骨矫正陈旧性脊柱结核角状后凸具有良好的后凸矫形效果。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of non-apex vertebral osteotomy for the cor- rection of angular kyphosis of old thoracolumbar tuberculosis. [Methods] A total of 14 patients received non-apex osteotomy and instrument- ed fusion for correction angular kyphosis of old thoracolumbar tuberculosis. After the involved segments were fully exposed through the poste- rior approach, the pedicle screws including 4 pairs on the cephalic side and 3 pairs on the caudal side were placed, and bilateral rods were in- stalled for temporary fixation. The vertebrae with relatively normal anatomical structure below the apex vertebrae were selected for perform- ing total vertebral osteotomy. The bilateral screw-rods were adjusted alternately with body position adjustment to gradually correct the defor- mity. Locking the screw- rod system, posterolateral bone grafting and the wound closed in layers were conducted. [Results] All the 14 pa- tients successfully completed the operation, with operation time of (9.8±2.3) hours and intraoperative blood loss of (2 150.0±937.9) ml. One patient developed paraplegia below the osteotomy plane after surgery, and no significant recovery of perianal and lower limb sensation and motor function was observed at 1 year postoperatively. All patients were followed up for more than 12 months. Compared with those preopera- tively, the VAS score significantly decreased [(3.1±1.1), (1.5±0.5), P＜0.001], while the ODI remained unchanged [(9.7±1.7), (9.9±4.6), P＞ 0.05] at the latest follow-up. Radiographically, compared with those preoperatively, the sagittal Cobb angle [(151.1±28.7)°, (19.7±5.2)°, P＜ 0.001], sagittal vertical axis [(28.9 ±11.6) mm, (3.9±2.8) mm, P＜0.001], sacral slope [(14.1±5.3)°, (22.3±5.6)°, P＜0.001], and pelvic tilt [(23.9±7.2)°, (13.8±5.0)°, P＜0.001] significantly improved postoperatively, whereas without a significant change in pelvic incidence [(37.6± 7.9)°, (35.4±8.1)°, P＞0.05]. [Conclusion] The non-apex vertebral osteotomy does achieve satisfactory correction for angular kyphosis of old thoracolumbar tuberculosis.