评价后路闭合-开放楔形截骨术治疗儿童先天性脊柱后凸畸形的安全性和有效性。
回顾性分析2010年1月至2019年12月后路闭合-开放楔形截骨治疗先天性脊柱后凸的影像学和临床资料,随访至少2年。围手术期指标如手术时间、截骨部位,截骨方法和并发症的发生,并观察影像学指标。3D打印模型用于测量前边缘椎骨的扩展距离和椎管线的闭合长度。通过SRS-22问卷评价临床效果。
本研究共有15名CK患者。截骨节段和细节如下:T6-9和L2各1例,T112例,T123例,L16例。平均手术时间为314min,平均失血970mL,平均融合范围为6.3段,平均随访时间70.5个月。局部后凸的Cobb角由65.6±18.8°校正为11.3±7.1°(p<.001)。后凸矫正范围为40-90°,平均矫正率为83.2%(67.7-95.7%)。随访中校正稳定,后凸角为11.0±7.6(p=0.68)。术前SVA为31.5±21.8mm,术后恢复18.0±15.5,末次随访9.1±7.9。p值分别为0.02和0.07。通过使用3D打印模型,椎体前缘扩张距离和椎管线闭合长度分别为14.5±7.5mm和24.5±8.0mm。SRS-22的自我形象和满意度显著提高。畸形和交界性脊柱后凸无复发。
后路闭合-开放楔形截骨术治疗儿童先天性脊柱后凸畸形是令人满意的,如果选择得当。在纵向随访期间,患者可以实现牢固融合,并且可以很好地维持矫正。信心的证据:IVa。
To evaluate the safety and effectiveness of posterior closed-open wedge osteotomy for treatment of congenital kyphosis in children.
Imaging and clinical data from January 2010 to December 2019 of posterior closed-open wedge osteotomy of congenital kyphosis with at least 2-year follow up was analyzed retrospectively. Perioperative indicators such as operation time, osteotomy site, osteotomy method and occurrence of complications, and imaging indicators were observed. The 3D printed models were used to measure the expanded distance of anterior edge vertebra and closed length of spinal canal line. The clinical effect was evaluated through SRS-22 questionnaires.
There were 15 CK patients in this study. The osteotomy segments and details are as follows: 1 case each for T6-9 and L2, 2 cases at T11, 3 cases at T12, and 6 cases at L1. The average operation time was 314 min, the average blood loss was 970 mL, the average fusion range was 6.3 segments, and the average time of follow up was 70.5 months. The Cobb angle of local kyphosis was corrected from 65.6 ± 18.8° to 11.3 ± 7.1°(p < .001). The range of kyphosis correction was 40-90°, and average correction rate was 83.2% (67.7-95.7%). The correction was stable in follow-up, and the kyphotic angle was 11.0 ± 7.6 (p = .68). The preoperative SVA was 31.5 ± 21.8 mm, and the postoperative recovery was 18.0 ± 15.5, while the last follow-up was 9.1 ± 7.9. The p values were 0.02 and 0.07 respectively. By using 3D printed models, the expanded distance of anterior edge vertebra and closed length of spinal canal line were 14.5 ± 7.5 mm and 24.5 ± 8.0 mm respectively. Self-image and satisfaction in SRS-22 improved significantly. There was no recurrence of deformity and junctional kyphosis.
The posterior closing-opening wedge osteotom for treatment of congenital kyphosis in children is satisfactory, if selected appropriately. During the longitudinal follow-up, the patients could achieve solid fusion and the correction could be well maintained.Evidence of Confidence: IVa.