退变性脊柱畸形截骨多节段经椎间孔椎间融合

Posterior column osteotomy combined with multi-level transforaminal lumbar interbody fusion for degenerative spinal de⁃ formity

摘要:

［目的］ 评价脊柱后柱截骨 （posterior column osteotomy, PCO） 联合局部经椎间孔入路腰椎椎间融合术 （transforami- nal lumbar interbody fusion, TLIF） 治疗退变性脊柱侧后凸畸形的效果。［方法］ 回顾性分析郑州市骨科医院 2018 年 1 月—2021 年 6 月手术治疗的退变性脊柱侧后凸畸形 71 例患者的临床资料。依据术前医患沟通结果，40 例采用 PCO 联合局部 TLIF （截骨融合组），另外 31 例采用≥3 级截骨矫形固定术 （截骨固定组）。比较两组围术期情况、随访结果和影像评估指标。［结果］ 截骨融合组并发症发生率为 7.5%（3/40），截骨固定组为 25.8%（8/31），差异有统计学意义（P=0.034）。截骨融合组手术时间、 术中失血量、下地行走时间、完全负重活动时间均优于截骨固定组（P<0.05），两组切口总长度、术中透视次数、切口愈合等级、 住院时间比较差异均无统计学意义（P>0.05）。随访 12 个月以上，随时间推移，两组 VAS 和 ODI 评分显著减少（P<0.05），JOA 评分显著增加（P<0.05）。出院时截骨融合组的上述临床评分均显著优于截骨固定组（P<0.05）。影像方面，与术前相比，术后即刻和末次随访时两组主弯冠状面 Cobb 角、矢状面 Cobb 角、冠状面平衡和矢状面平衡均显著改善（P<0.05）；相应时间点，两组间上述影像指标的差异均无统计学意义（P>0.05）。末次随访时两组均无钉棒松动、断裂等不良影像表现。［结论］对退变性脊柱侧后凸畸形患者采用 PCO 联合局部 TLIF 效果良好，且可减轻手术创伤、降低手术风险、加快术后康复、减少并发症。

Abstract:

[Objective] To evaluate the clinical outcomes of posterior column osteotomy (PCO) combined with local multi-level transfo- raminal lumbar interbody fusion (TLIF) in the treatment of degenerative scoliokyphosis. [Methods] A retrospective study was performed on 71 patients who received surgical treatment for degenerative spine deformity in our hospital from January 2018 to June 2021. Based on preop- erative doctor-patient communication, 40 patients received PCO combined with local mutipl-level TLIF (PCO-MF group) , while the re- maining 31 patients received grade ≥3 osteotomy and fixation (OF group) . The documents regarding perioperative conditions, follow-up and radiographs were compared between the two groups. [Results] The incidence of early complications was of 7.5% (3/40) in the PCO- MF group, whereas 25.8% (8/31) in the OF group, which was statistically significant (P=0.034) . The PCO-MF group proved significantly superi- or to the OF group in terms of operative time, intraoperative blood loss, postoperative walking time and full weight-bearing activity time (P＜ 0.05) , although there were no significant differences in the total incision length, intraoperative fluoroscopy times, incision healing and hospi- tal stay between the two groups (P＞0.05) . With time of follow-up for more than 12 months, the VAS and ODI scores significantly decreased (P＜0.05) , while JOA score significantly increased in both groups (P＜0.05) , which in the PCO-MF group was significantly better than those in the OF group at discharge (P＜0.05) . Radiographically, the main curved coronal Cobb angle, sagittal Cobb angle, coronal balance and sag- ittal balance significantly improved in both groups immediately after surgery and at the latest follow-up compared with those preoperatively (P＜0.05) , nevertheless no significant differences in the above image parameters were noted between the two groups at any time point accord- ingly (P＞0.05) . At the latest follow-up, non-patient in both groups had adverse imaging manifestations such as loosening and fracture of the implants. [Conclusion] PCO combined with local multi-level TLIF is an effective treatment for degenerative spinal deformity, and does re- duce surgical trauma, reduce surgical risk, accelerate postoperative rehabilitation, and reduce complications.