One-stage posterior-only lumbosacral hemivertebra resection with short segmental fusion: a more than 2-year follow-up
One-stage posterior-only lumbosacral hemivertebra resection with short segmental fusion: a more than 2-year follow-up
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DOI：
10.1007/s00586-015-3995-x
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发表时间：
2016-05-01
影响因子：
2.8
通讯作者：
Qiu, Guixing
中科院分区：
文献类型：
--
作者：
Zhuang, Qianyu;Zhang, Jianguo;Qiu, Guixing
前言：腰骶半椎体是一个独特的问题，因为它会导致严重的失衡和进行性的代偿性胸腰椎畸形。以往的研究已经报道了前后路联合入路的腰椎半椎体切除，但还没有关于后路半椎体切除的结果和并发症的报道。材料与方法本研究收集了一个前瞻性的数据库，包括连续的14例腰骶半椎体先天性脊柱侧弯患者，采用一期后路半椎体切除短节段融合治疗，至少随访2年(24-144个月)。复习手术报告和病历。放射学评估包括测量节段性脊柱侧弯和前凸、代偿性脊柱侧弯、胸椎后凸、腰椎前凸和躯干移位的变化。同时收集脊柱侧弯研究会(SRS)的22份生活质量调查问卷。平均融合节段为3.2个节段。平均手术时间207.8 m in，平均出血量235.7 m l，平均节段性脊柱侧凸30°，术后平均5°(矫正率83%)，术后随访平均4°(87%)。在最近的随访中，30度的代偿性冠状曲线自然矫正为13度。术后躯干移位在冠状面(63%)和矢状面(58%)均有明显改善，并在随访期间保持稳定。SRS-22总分、自我形象域和满意度总分均较术前有显著改善。术中仅观察到一个并发症，椎弓根骨折。结论综上所述，经后路一期高压性切除短节段植骨融合术可提供良好的脊柱侧弯矫正和躯干移位改善，且无神经并发症，同时尽可能保留活动节段。这一策略不仅矫正了畸形，而且防止了代偿性曲度的进展，从而避免了长时间的腰椎融合。
Introduction Lumbosacral hemivertebra poses a unique problem because it can cause gross imbalance and progressive compensatory thoracolumbar deformity. Previous studies have reported lumbosacral hemivertebra resection through a combined anterior and posterior approach, but there have been no reports on the results and complications of hemivertebra resection via a posterior-only procedure and short fusion with large series of patients.Materials and methods This retrospective study of a prospective collected database comprises a consecutive series of 14 congenital scoliosis due to lumbosacral hemivertebra treated by 1-stage posterior hemivertebra resection with short segmental fusion, with at least a 2-year follow-up period (24-144 months). Surgical reports and patient charts were reviewed. Radiographic evaluation included measured changes in segmental scoliosis and lordosis, compensatory scoliosis, thoracic kyphosis, lumbar lordosis, and trunk shift. Quality of life data from Scoliosis Research Society (SRS)-22 questionnaires were also collected.Results Our results showed that the mean follow-up period was 38.4 months. The mean fusion level was 3.2 segments. Mean operation time was 207.8 min with the average blood loss of 235.7 ml. The mean segmental scoliosis was 30 degrees preoperatively, 5 degrees postoperatively (83 % correction rate), and 4 degrees (87 %) at the latest follow-up. The compensatory coronal curve of 30 degrees was spontaneously corrected to 13 degrees at most recent follow-up. Trunk shift was significantly improved on both coronal (63 %) and sagittal plane (58 %) after the surgery, and kept stable during the follow-up. The total SRS-22 score, the self-image domain score and the satisfaction domain score demonstrated significant improvement compared with preoperative status. Only one intra-operative complication was observed, a pedicle fracture.Conclusions In summary, our results showed that one-stage HV resection and short segment fusion by a posterior approach can offer excellent scoliosis correction and trunk shift improvement without neurological complications, while saving motion segments as much as possible. This strategy is not only corrective of the deformity but also preventive of compensatory curve progression, thus avoiding long lumbar fusion.