摘要
目的探讨Ponte截骨联合骨桥切断和椎间隙植骨治疗僵硬性退变性脊柱侧凸的疗效。方法回顾性分析2017年3月至2021年10月采用Ponte截骨联合骨桥切断和椎间隙松解植骨治疗僵硬性退变性脊柱侧凸的患者资料,男7例、女14例;年龄(67.6±9.1)岁(范围59~76岁)。所有患者均有顽固性腰痛伴行走受限,15例伴下肢放射性疼痛。术前站立位腰椎正侧位X线片示侧凸Cobb角为51.3°±24.1°(范围36°~61°)、腰椎前凸Cobb角为5.4°±13.6°(范围-10°~19°)。脊柱冠状面平衡(coronal balance distance,CBD)即C 7铅垂线(C 7 plumb line,C 7 PL)与骶骨中垂线(center sacral vertical line,CSVL)的距离为(4.3±2.0)cm(范围0.5~6.2 cm)。矢状面平衡(sagittal vertical axis,SVA)即C 7 PL与S 1后上缘的距离为(5.9±3.1)cm(范围1.5~6.8 cm)。所有患者顶椎区均有巨大骨赘和骨桥,伴明显的成角和旋转畸形。仰卧位左右bending像示侧凸僵硬、活动度差。行多节段Ponte截骨,切断顶椎区骨桥,在顶椎区和滑移或半脱位节段行椎间隙松解和颗粒植骨。采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)和站立位脊柱全长正侧位X线片评估手术疗效和畸形改善情况。结果所有患者均顺利完成手术。手术时间(250±68)min范围(190~330 min),术中出血(970±260)ml(范围700~1600 ml)。术后随访时间为(20.6±7.2)个月(范围12~36个月)。无一例患者出现内固定失效、断裂或翻修。末次随访时腰痛VAS由术前的(6.1±2.2)分降至(2.1±1.8)分(t=6.45,P<0.001),腿痛由术前的(5.5±3.4)分降至(1.2±1.0)分(t=5.56,P<0.001);ODI自术前的52.2%±22.2%降至16.4%±10.6%(t=6.67,P<0.001)。术后腰椎侧凸Cobb角为19.3°±10.5°(范围16°~29°),与术前相比差异有统计学意义(t=5.58,P<0.001)。术后腰椎前凸Cobb角增加至34.4°±15.6°(范围27°~46°),与术前相比差异有统计学意义(t=6.64,P<0.001)。CBD下降至(1.9±1.1)cm,与术前相比差异有统计学意义(t=4.42,P<0.001)。SVA下降至(1.6±2.1)cm,与术前相比差异有统计学意义(t=4.90,P<0.001)。结论Ponte截骨联合骨桥切断和椎间隙植骨可以改善成人僵硬性退变性脊柱侧凸的脊柱序列以及矢状面和冠状面平衡、避免椎体截骨,是治疗成人僵硬性退变性脊柱侧凸的有效方法。
Objective To investigate the effect of Ponte osteotomy combined with bony bridge dissection and intervertebral bone grafting in the treatment of rigid degenerative scoliosis.Methods From March 2017 to October 2021,this method was used to treat 21 cases of rigid degenerative scoliosis,including 7 males and 14 females,aged 59-76 years,with an average age of 67.6 years.All patients had intractable low back pain and limited standing and walking,while 15 patients had radiation pain in lower limbs.The preoperative standing X-ray film showed that the average Cobb angle of lumbar scoliosis was 51.3°±24.1°,the average lumbar lordosis was 5.4°±13.6°.The coronal balance distance(CBD)was 4.3±2.0 cm(range,0.5-6.2 cm),and the sagittal vertical axis(SVA)was 5.9±3.1 cm(range,1.5-6.8 cm).The bending images showed huge osteophyte with bone bridge formation in the vertebral body of the apex region,with poor mobility.Ponte osteotomy was performed according to the degeneration of the deformity.The bone bridge at apex area was cut off,and the intervertebral spaces at apex area and slipped or subluxated levels were release and grafted with granular autogenous decompression bone.During follow-up,the efficacy and deformity improvement were evaluated with visual analogue scale(VAS),Oswestry disability index(ODI)and standing X-ray films.Results All patients successfully completed the operation.The operation time was 190-330 min,with an average of 250±68 min.The intraoperative bleeding was 700-1600 ml,with an average of 970±260ml.The patients were followed up for 12-36 months,with an average of 20.6±7.2 months.No internal fixation failure,fracture or revision occurred.At the last follow-up,the VAS of low back pain decreased from preoperative 6.1±2.2 to 2.1±1.8(t=6.45,P<0.001),and the leg pain decreased from 5.5±3.4 to 1.2±1.0(t=5.56,P<0.001).ODI decreased from 52.2%±22.2%to 16.4%±10.6%(t=6.67,P<0.001).The Cobb angle of lumbar scoliosis was 19.3°±10.5°,with an average correction rate of 62.4%;lumbar lordosis was 34.4°±15.6°,with average correction of 30°.CBD was 1.9±1.1 cm,with an average correction of 2.4 cm(t=4.42,P<0.001);and SVA was 1.6±2.1 cm,with an average correction of 4.3 cm(t=4.90,P<0.001).Conclusion Ponte osteotomy combined with bone bridge dissection and intervertebral bone grafting is an effective method to treat rigid degenerative scoliosis,which can improve spinal sequence,CBD and SVA,avoid vertebral osteotomy and reduce fusion segments.
作者
徐宝山
黎宁
许海委
马信龙
Xu Baoshan;Li Ning;Xu Haiwei;Ma Xinlong(Department of Spine Surgery,Tianjin Hospital,Tianjin 300211,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2023年第6期343-350,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金(82072491)
天津市自然科学基金(20JCYBJC00820)
天津市医学重点学科(专科)建设资助项目(TJYXZDXK-026A)
