Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100 Clinical article
Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100 Clinical article
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DOI：
10.3171/2012.9.spine111026
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发表时间：
2012-12-01
影响因子：
2.8
通讯作者：
Liu, Luping
中科院分区：
文献类型：
--
作者：
Xie, Jingming;Wang, Yingsong;Liu, Luping
Object.严重和僵硬的脊柱畸形的手术治疗带来了困难和危险。在这篇文章中，作者总结了他们的手术技术，并评估了后路脊柱切除术（PVCR）矫正脊柱弯曲大于100度的患者结局，并调查了在这一具有挑战性的手术过程中确保神经安全性的关键点。作者回顾性分析了28例极重度（冠状面或矢状面Cobb角> 100度）和僵硬胸椎或胸腰椎畸形患者接受PVCR的经验。患者平均年龄为20.2岁，所有患者均接受了至少24个月的随访（范围24-60个月）。患者根据其形态学分类分组如下：单纯脊柱后凸（A组，6例患者，平均Cobb角为109.0度[范围105度-120度]）;脊柱后凸，冠状面曲线明显大于矢状面曲线（B组，14名患者，平均脊柱侧凸曲线为116.6度[范围102度-170度]，脊柱后凸曲线为77.7度[范围42度-160度]）;矢状面曲线明显大于冠状面曲线的脊柱后凸（C组，8例患者的平均冠状面弯曲度为85.4度[范围65度-110度]，平均矢状面弯曲度为117.6度[范围102度-155度]）结果。28例严重僵硬脊柱畸形患者共切除36个椎体，平均融合范围为13.3个椎体（范围7-17个椎体）。平均手术时间为620分钟（范围320-920分钟），平均手术失血量为6，680 ml（范围3，000 - 24，000 ml）。脊柱侧凸的总体最终矫正率为59.0%，平均术后后凸Cobb角范围为30.4 °至95.9 °。A组术前平均矢状角为109.0 °，术后平均矢状角为32.0 °。B组患者冠状面矫正率为58.6%，矢状面CobB角由术前平均77.7 °矫正至术后平均25.1 °; C组冠状面矫正率为58.5%，平均矢状角由术前的平均117.6 °降至39.0 °。在接受PVCR的28例患者中，18例患者在术中和术后观察到46例并发症。有5例神经系统并发症，包括1例迟发性瘫痪和4例胸神经根疼痛，所有这些都在早期随访期间解决。脊柱后凸患者更常发生非神经系统并发症（41例并发症）。所有患者的平均随访时间为33.7个月（范围24-60个月）。后路脊柱切除术能有效矫正严重的僵硬脊柱畸形，尽管该手术技术要求高，耗时长，并伴有各种并发症。PVCR技术为脊柱矫正和脊髓张力调整创造了空间，并且可以在直接检查下和通过空间触诊脊髓中的张力来进行矫正。因此，就脊髓而言，PVCR手术涉及的畸形矫正过程相对安全。(http：//thejns.org/doi/abs/10.3171/2012.9.SPINE111026）
Object. The surgical treatment of severe and rigid spinal deformities poses difficulties and dangers. In this article, the authors summarize their surgical techniques and evaluate patient outcomes after performing posterior vertebral column resection (PVCR) for the correction of spinal deformities with curves greater than 100 degrees, and investigate the crucial points to ensure neurological safety during this challenging procedure.Methods. The authors retrospectively reviewed their experience with 28 patients with extremely severe (Cobb angles in the coronal or sagittal plane > 100 degrees) and rigid thoracic or thoracolumbar spine deformities who underwent PVCR. The average patient age was 20.2 years and all patients underwent a minimum follow-up of 24 months (range 24-60 months). Patients were divided into groups according to their morphological classification as follows: kyphosis alone (Group A, 6 patients with a mean Cobb angle of 109.0 degrees [range 105 degrees-120 degrees]); kyphoscoliosis with coronal plane curves notably greater than sagittal plane curves (Group B, 14 patients with mean scoliotic curves of 116.6 degrees [range 102 degrees-170 degrees] and kyphotic curves of 77.7 degrees [range 42 degrees-160 degrees]); and kyphoscoliosis with sagittal curves notably greater than coronal plane curves (Group C, 8 patients with a mean coronal curve of 85.4 degrees [range 65 degrees-110 degrees] and a mean sagittal curve of 117.6 degrees [range 102 degrees-155 degrees]).Results. A total of 36 vertebrae were removed in 28 patients who had a severe rigid spinal deformity, and the mean fusion extent was 13.3 vertebrae (range 7-17 vertebrae). The mean operating time was 620 minutes (range 320-920 minutes) with an average operative blood loss of 6,680 ml (range 3,000-24,000 ml). The overall final correction rate of scoliosis was 59.0%, and average postoperative kyphotic Cobb angles ranged from 30.4 degrees to 95.9 degrees. In Group A the mean preoperative sagittal angle of 109.0 degrees was corrected to a mean postoperative angle of 32.0 degrees. In the Group B kyphoscoliotic patients, the correction rate in the coronal plane was 58.6%; the Cobb angle in the sagittal plane was corrected from a mean of 77.7 degrees preoperatively to 25.1 degrees postoperatively; in Group C, the correction rate in the coronal plane was 58.5%, and the mean sagittal angle was reduced from a mean of 117.6 degrees preoperatively to 39.0 degrees. Of the 28 patients who underwent PVCR, 46 complications were observed in 18 patients intra- and postoperatively. There were 5 neurological complications including 1 case of late-onset paralysis and 4 cases of thoracic nerve root pain, all of which resolved during the early follow-up period. Nonneurological complications occurred more often in kyphoscoliotic patients (41 complications). The mean follow-up of all patients was 33.7 months (range 24-60 months).Conclusions. Posterior vertebral column resection was effective in correcting severe rigid spinal deformity, although the procedure was technically demanding, exhaustingly lengthy, and was associated with a variety of complications. The PVCR technique created a space for spinal correction and spinal cord tension adjustment and the correction could be performed under direct inspection and by palpation of the tension in the spinal cord through the space. Therefore, in terms of the spinal cord, the deformity correction process involved in the PVCR procedure is relatively safe. (http://thejns.org/doi/abs/10.3171/2012.9.SPINE111026)