目的 探討對于中重度脊柱側后凸畸形，采用經椎弓根截骨（pedicle subtraction osteotomy，PSO）技術和非截骨技術治療的臨床效果。 方法 2005 年1 月－ 2009 年1 月，對99 例中重度脊柱側后凸畸形患者分別采用PSO截骨（PSO 截骨組，46 例）和非截骨技術（非截骨組，53 例）行后路矯形治療。兩組患者性別、年齡、術前主側凸Cobb 角、胸腰段后凸Cobb 角等一般資料比較差異無統(tǒng)計學意義（P gt; 0.05），有可比性。分別記錄兩組手術時間、出血量，術后測量脊柱主側凸Cobb 角、胸腰段后凸Cobb 角，并計算側凸和后凸矯正率以及末次隨訪的矯正率丟失。 結果 患者均順利完成手術。PSO 截骨組患者手術時間和出血量均多于非截骨組，比較差異有統(tǒng)計學意義（P lt; 0.05）。所有患者均獲隨訪，隨訪時間12 ～ 56 個月，平均22.4 個月。兩組均未出現(xiàn)脊髓神經損傷，末次隨訪時均獲得良好的骨性融合。兩組患者術后2 周及末次隨訪時的主側凸Cobb 角及胸腰段后凸Cobb 角均較術前顯著改善（P lt; 0.05）。術后2 個時間點的主側凸Cobb 角、矯正率兩組間比較差異均無統(tǒng)計學意義（P gt; 0.05）；但PSO 截骨組末次隨訪時的矯正率丟失明顯小于非截骨組（P lt; 0.05）。術后2 個時間點的胸腰段后凸Cobb 角、矯正率及矯正率丟失，PSO 截骨組均優(yōu)于非截骨組，差異有統(tǒng)計學意義（P lt; 0.05）。 結論 對于中重度脊柱側后凸畸形，PSO 截骨技術較非截骨技術在冠狀面?zhèn)韧沟某C形方面無顯著差異，但能夠獲得更好的脊柱矢狀面后凸矯形效果；但PSO 截骨的手術時間和出血量會顯著增加。
引用本文： 周建偉,彭晉升,楊濱,牛晶,陳志明,王曉平,李佳,馬華松. 經椎弓根截骨與非截骨技術治療中重度脊柱側后凸的臨床研究. 中國修復重建外科雜志, 2012, 26(4): 406-410. doi: 復制
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| 2. | Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152. |
| 3. | Halm H. Pedicle subtraction osteotomy for correction of congenital scoliokyphosis. Eur Spine J, 2011, 20(6): 995-996. |
| 4. | Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104. |
| 5. | Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine (Phila Pa 1976), 2009, 34(14): 1504-1512. |
| 6. | Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50. |
| 7. | 劉濤, 馬華松, 周建偉, 等. 經椎弓根截骨凸側懸臂梁技術治療重度僵硬性先天性脊柱側后凸. 中國骨腫瘤骨病雜志, 2011, 10(5): 355-359. |
| 8. | 陳志明, 馬華松, 譚榮, 等. 重度僵硬后凸型脊柱側凸畸形的手術治療. 中國骨與關節(jié)外科, 2011, 4(1): 27-31. |
| 9. | 馬華松, 周建偉, 鄒德威, 等. 重度僵硬型脊柱側凸的后路非全椎體截骨手術治療. 中國矯形外科雜志, 2010, 18(16): 1323-1326. |
| 10. | 張宏其, 魯世金, 陳靜, 等. 廣泛后路松解三維矯形治療重度特發(fā)性脊柱側凸. 中國脊柱脊髓雜志, 2007, 17(4): 274-279. |
| 11. | Burton DC, Sama AA, Asher MA, et al. The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine (Phila Pa 1976), 2005, 30(17): 1979-1984. |
| 12. | Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2038. |
| 13. | Kim KT, Park KJ, Lee JH. Osteotomy of the spine to correct the spinal deformity. Asian Spine J, 2009, 3(2): 113-123. |
| 14. | Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-178. |
| 15. | Hyun SJ, Rhim SC. Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc, 2010, 47(2): 95-101. |
| 16. | Heary RF, Albert TJ. 脊柱畸形精要. 李明, 王巖, 陳仲強, 等譯. 上海: 上?？茖W技術出版社, 2009: 67-68. |
| 17. | 鄒德威, 譚榮. 三柱截骨治療重度僵硬性脊柱側凸的手術決策和風險規(guī)避. 中華外科雜志, 2010, 48(11): 1691-1693. |
| 18. | Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104. |
| 19. | Baldus CR, Bridwell KH, Lenke LG, et al. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine (Phila Pa 1976), 2010, 35(2): 235-239. |
| 20. | Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687. |
| 21. | Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between smith-petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2011. [Epub ahead of print]. |
- 1. Heining CF. Eggshell procedure//Luque ER, eds. Segmental Spinal Instrumentation. Thorofare, New Jersey: Slack, 1984: 221-234.
- 2. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
- 3. Halm H. Pedicle subtraction osteotomy for correction of congenital scoliokyphosis. Eur Spine J, 2011, 20(6): 995-996.
- 4. Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
- 5. Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine (Phila Pa 1976), 2009, 34(14): 1504-1512.
- 6. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50.
- 7. 劉濤, 馬華松, 周建偉, 等. 經椎弓根截骨凸側懸臂梁技術治療重度僵硬性先天性脊柱側后凸. 中國骨腫瘤骨病雜志, 2011, 10(5): 355-359.
- 8. 陳志明, 馬華松, 譚榮, 等. 重度僵硬后凸型脊柱側凸畸形的手術治療. 中國骨與關節(jié)外科, 2011, 4(1): 27-31.
- 9. 馬華松, 周建偉, 鄒德威, 等. 重度僵硬型脊柱側凸的后路非全椎體截骨手術治療. 中國矯形外科雜志, 2010, 18(16): 1323-1326.
- 10. 張宏其, 魯世金, 陳靜, 等. 廣泛后路松解三維矯形治療重度特發(fā)性脊柱側凸. 中國脊柱脊髓雜志, 2007, 17(4): 274-279.
- 11. Burton DC, Sama AA, Asher MA, et al. The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine (Phila Pa 1976), 2005, 30(17): 1979-1984.
- 12. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2038.
- 13. Kim KT, Park KJ, Lee JH. Osteotomy of the spine to correct the spinal deformity. Asian Spine J, 2009, 3(2): 113-123.
- 14. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-178.
- 15. Hyun SJ, Rhim SC. Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc, 2010, 47(2): 95-101.
- 16. Heary RF, Albert TJ. 脊柱畸形精要. 李明, 王巖, 陳仲強, 等譯. 上海: 上?？茖W技術出版社, 2009: 67-68.
- 17. 鄒德威, 譚榮. 三柱截骨治療重度僵硬性脊柱側凸的手術決策和風險規(guī)避. 中華外科雜志, 2010, 48(11): 1691-1693.
- 18. Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
- 19. Baldus CR, Bridwell KH, Lenke LG, et al. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine (Phila Pa 1976), 2010, 35(2): 235-239.
- 20. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
- 21. Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between smith-petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2011. [Epub ahead of print].