Bai Yunsong,Zhang Xuejun,Gao Rongxuan,et al.Posterior-only multi-segment Ponte osteotomies with internal fixation and fusion in adolescent Scheuermann’s kyphosis[J].Journal of Clinical Pediatric Surgery,2021,20(08):737-742.[doi:10.12260/lcxewkzz.2021.08.007]
后路多节段Ponte截骨矫形固定术治疗青少年休门氏脊柱后凸畸形疗效分析
- Title:
- Posterior-only multi-segment Ponte osteotomies with internal fixation and fusion in adolescent Scheuermann’s kyphosis
- 关键词:
- Scheuermann病; 脊柱后凸; Ponte截骨; 治疗结果; 青少年
- Keywords:
- Scheuermann Disease; Kyphosis; Ponte osteotomy; Treatment Outcome; Adolescent
- 分类号:
- R682.3;R726.8
- 摘要:
- 目的 评价后路多节段Ponte截骨矫形固定术治疗青少年休门氏脊柱后凸畸形（scheuerman’s disease，SK）的手术效果及对脊柱-骨盆矢状位参数的影响。方法 回顾性分析2012年7月至2018年12月首都医科大学附属北京儿童医院诊治的18例青少年SK患者的临床资料，其中男14例，女4例；年龄11~15岁，平均（13.2±1.9）岁。所有患者接受后路多节段Ponte截骨矫形固定手术，随访时间至少24个月。术前、术后及末次随访时所有患者行站立位全脊柱正侧位X线检查。对比术前、术后以及末次随访时全脊柱最大后凸角（global kyphosis，GK）、近端交界角（proximal junctional angle，PJA）、远端交界角（distal junctional angle，DJA）、胸椎后凸（thoracic kyphosis，TK）、腰椎前凸（lumbar lordosis，LL）、矢状面平衡（sagittal vertical axis，SVA）以及骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）的变化。结果 随访24~70个月，平均（38.10±15.32）个月；Ponte截骨节段为6~9个，平均（7.4±1.1）个；术后即刻GK较术前明显降低（P<0.05），由术前的（78.3±10.6）°下降至术后即刻的（32.3±8.4）°，术后即刻矫正率达58.7%，末次随访时为（34.1±6.2）°，与术后即刻无明显差异（P>0.05）；术后即刻TK、LL较术前降低（P<0.05），与末次随访时比较差异无统计学意义（P>0.05）。PJA、DJA、SVA及骨盆矢状位参数（PI、PT、SS），术后即刻、末次随访时与术前比较差异均无统计学意义（P>0.05）。所有患者无神经系统并发症。矫形手术对脊柱-骨盆矢状位序列无明显影响。随访过程中未见近端交界性后凸、远端交界性后凸，无内固定失败、感染和假关节形成等并发症。结论 后路多节段Ponte截骨矫形固定术治疗青少年SK安全、有效，至少2年随访结果是满意的，此类手术并不影响脊柱-骨盆矢状位参数。
- Abstract:
- Objective To evaluate the surgical outcomes of posterior-only multi-segment Ponte osteotomies with internal fixation and fusion for adolescent Scheuermann’s kyphosis (SK). Methods Clinical data were retrospectively reviewed for 18 undergoing posterior-only multi-segment Ponte osteotomies with internal fixation and fusion from July 2012 to December 2018. There are 14 boys and 4 girls with an average age of (6.50±3.22)(2.17-13.00) years. Standing anteroposterior and lateral radiographs of full-spine were recorded and compared preoperatively, postoperatively and at the last follow-up. Radiographic parameters included global kyphosis (GK), proximal junctional angle (PJA), distal junctional angle (DJA), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Results The mean follow-up period was (38.10±15.32)(24-70) months. Ponte osteotomy segments had an average of (7.4±1.1)(6-9). GK was (78.3±10.6)°preoperatively, (32.3±8.4)° (correction rate of 58.7%) postoperatively and (34.1±6.2)° at the latest follow-up. TK and LL post-operation were significantly lower than those pre-operation (P<0.05) and there was no significant difference from the last follow-up (P>0.05). PJA, DJA, SVA and sagittal spinopelvic parameters (PI/PT/SS) were not significantly different from those pre-operation and the last follow-up (P>0.05). There was no occurrence of neurologic complication, proximal junctional kyphosis, distal junctional kyphosis, infection, pseudarthrosis, correction loss or instrumentation-related complication during follow-ups. Conclusion Posterior-only multi-segment Ponte osteotomies with internal fixation and fusion is both safe and effective for adolescent SK. And surgical outcomes were satisfactory during a follow-up period of over 2 years. In our experience, the spinopelvic parameters did not change after surgery.
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备注/Memo
收稿日期:2021-06-07。
基金项目:北京市医院管理局临床技术创新项目（扬帆）
通讯作者:张学军,Email:zhang-x-j04@163.com