目的 探讨应用全脊柱椎体切除技术治疗重度僵硬性胸腰椎侧后凸畸形的有效性及安全性.方法 选择2010年9月至2016年9月期间,我科行全脊柱椎体切除技术治疗的13例重度僵硬性胸腰椎侧后凸畸形患者,其中女9例,男4例;年龄12~18岁,平均16.1岁.所有入选患者均于手术前后行站立位全脊柱正侧位及双侧Bending位X线检查并测量手术前后的侧凸Cobb's角、最大后凸Cobb's角、骨盆参数、冠状面平衡参数即C7铅垂线至骶骨中垂线的距离(C7 plumb line-center sacral vertical line,C7PL-CSVL)和矢状位平衡(sagittal vertical axis,SVA)及脊柱柔韧性等影像学相关参数,同时分别在手术前后采用SRS-22、疼痛视觉模拟评分(visual analogue scale,VAS)、SF-36等量表评估其临床效果.结果 术后随访时间6~24个月,平均12个月,手术时间240~580 min,平均(426.8±86.2)min,术中出血量1500~11000 ml,平均(6086.0±3024.6)ml.术前侧凸Cobb's角(95.6±10.1)°,后凸Cobb's角(103.6±16.8)°,柔韧性为(26.2±4.3)%,C7PL-CSVL(62.4±11.3)mm,SVA(54.6±26.2)mm;术后侧凸Cobb's角(29.2±7.7)°,后凸Cobb's角(28.1±10.4)°,C7PL-CSVL(18.8±6.2)mm,SVA(28.1±10.8)mm,均较术前明显改善,差异有统计学意义(P<0.05).末次随访时侧凸Cobb's角(31.1±10.1)°,后凸Cobb's角(29.3±4.0)°,C7PL-CSVL(21.9±4.6)mm,SVA(32.1±6.7)mm,所有患者术中脊髓监测未发现有体感诱发电位(somatosensory evoked potential,SEP)和运动诱发电位(motor evoked potential,MEP)异常改变,术中唤醒试验患者下肢运动感觉功能正常.1例出现胸膜撕裂伴左侧血胸,4例出现下肢远端一过性感觉功能减退,2例置钉位置不良,术后SRS-22、VAS、SF-36量表评分较术前比较均有明显改善,差异有统计学意义(P<0.05).结论 后路一期脊柱椎体切除术治疗重度僵硬性胸腰椎侧后凸畸形可有效矫正冠状位及矢状位畸形,术后整体平衡性重建效果良好,可显著改善患者生活质量,但同时应注意避免神经损伤等并发症发生.%Objective To evaluate the safety and clinical outcomes of vertebral column resection in the treatment of severe rigid kyphoscoliosis. Methods A total of 13 patients with severe rigid kyphoscoliosis underwent posterior vertebral column resection from September 2010 to September 2016. There were 9 females and 4 males with an average age of 16.1 years ( range: 12 - 18 years ). All the radiographic parameters were measured preoperatively, post-operatively. Pre-operative Bending Cobb's angle, Cobb's angle, the distance between C7 plumbline and center sacral vertical line ( C7PL-CSVL ), global kyphosis ( GK ), sagittal vertical axis ( SVA ), the SRS-22, VAS, SF-36 were evaluated pre-operation and post-operation. Results All the patients were followed up for an average of 12 months ( range: 6 - 24 months ). The operation lasted 240 - 580 min ( mean: 426.8 ± 86.2 min ). The mean blood loss was ( 6086.0 ± 3024.6 ) ml ( range: 1500 - 11000 ml ). The pre-operative Cobb's angle, GK angle, the spinal average flexibility, C7PL-CSVL, SVA were ( 95.6 ± 10.1 ) °, ( 103.6 ± 16.8 ) °, ( 26.2 ± 4.3 ) %, ( 62.4 ± 11.3 ) mm, ( 54.6 ± 26.2 ) mm. The post-operative Cobb's angle, GK angle, C7PL-CSVL, SVA were ( 29.2 ± 7.7 ) °, ( 28.1 ± 10.4 ) °, ( 18.8 ± 6.2 ) mm, ( 28.1 ± 10.8 ) mm. There were significant differences between the 2 groups ( P < 0.05 ). At the latest follow-up, Cobb's angle, GK angle, C7PL-CSVL, SVA were ( 31.1 ± 10.1 ) °, ( 29.3 ± 4.0 ) °, ( 21.9 ± 4.6 ) mm, ( 32.1 ± 6.7 ) mm. Intraoperative electrophysiological monitoring of somatosensory evoked potential ( SEP ) and motor evoked potentials ( MEP ) showed no changes. Postoperatively, 1 case had left hemothorax, 4 cases had lower extremity sensory dysfunction, 2 cases had pedicle screw malposition. SRS-22, VAS, SF-36 improved significantly after surgery ( P < 0.05 ). Conclusions One stage posterior vertebral column resection is safe and effective in the treatment of severe and rigid thoracolumbar kyphoscoliosis. It can achieve satisfactory correction and improve patients' life quality. However, attention should be paid to avoid complications.
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