摘要
目的:分析重度脊柱侧凸(severe scoliosis,SS)伴脊髓空洞(syringomyelia,SM)患者术前牵引和手术截骨矫形的效果,探讨术前牵引一期后路截骨矫形手术治疗SS伴SM(SS-SM)患者的安全性和有效性。方法:回顾2007年1月~2023年10月我院行术前牵引一期后路截骨矫形手术的40例SS-SM病例,男19例,女21例,年龄11~41岁(18.28±6.66岁)。所有患者既往无神经外科手术治疗史,术前均行全脊柱X线片、CT及MRI检查,测量冠状面主弯角度、矢状面后凸角度、SM的大小[最大脊髓空洞/脊髓比值(maximal syrinx/cord ratio,S/C)]和长度,观察是否合并Chiari畸形,计算畸形角度比(deformity angular ratio,DAR),牵引过程中及术后均适时复查全脊柱X线片,评估患者脊柱畸形矫正情况。根据SM是否合并ChiariⅠ型畸形(ChiariⅠmalformation,CMⅠ)分为合并CMI SM组(CMⅠ-related SM,CS组)与特发性SM组(idiopathic SM,IS组);根据SM的大小分为大空洞组(big syrinx,S/C>0.6,BS组)与小空洞组(little syrinx,S/C≤0.6,LS组),统计分析不同组患者术前牵引与手术对矫形的贡献率并进行比较(CS组vs IS组、BS组vs LS组)。结果:40例患者SM的S/C为0.59±0.18,长度为9.43±5.50个节段。36例术前行颅-股骨牵引(skull-femoral traction,SFT),4例行颅重力牵引(halo-gravity traction,HGT),牵引过程中5例出现暂时性局部麻木,2例出现暂时性局部肌力减退,5例发生牵引钉道感染。29例(72.5%)行低级别截骨,11例(27.5%)行高级别截骨脊柱短缩融合术,脊柱融合节段数平均为13.48±1.34节段。术后躯干局部麻木2例,肺部感染4例,浅部术口感染3例,均未发生运动功能障碍。术前冠状面主弯角度、矢状面后凸角度、术前总畸形角度比(total DAR,T-DAR)分别为104.80°±18.58°、66.57°±31.21°、25.73°±8.30°/节段,牵引后分别为65.55°±19.00°、44.95°±23.32°、16.73°±7.24°/节段,矫形术后侧凸和后凸角分别为37.78°±14.91°、29.95°±14.14°,主弯柔韧性
Objectives:To analyze the effects of preoperative traction and surgical osteotomy correction in patients with severe scoliosis(SS)accompanied by syringomyelia(SM),and explore the safety and efficacy of one-stage posterior osteotomy surgery following preoperative traction in treating patients with SS accompanied with SM(SS-SM).Methods:A retrospective study was conducted on 40 cases of SS-SM patients who underwent one-stage posterior osteotomy surgery following preoperative traction in our department from January 2007 to October 2023.There were 19 males and 21 females,aged 11 to 41 years(18.28±6.66 years).All the patients had no history of neurosurgical operational treatment and underwent full-spine X-rays,CT,and MRI examinations before surgery to measure the major curve angle on coronal plane,kyphosis angle on sagittal plane,length of SM,to evaluate whether combined with Chiari malformation,and to calculate the size of SM(maximal syrinx/cord ratio,S/C)and deformity angular ratio(DAR).During traction and after operation,full-spine X-rays were re-examined in a timely manner to assess the correction conditions of deformity.According to whether SM was accompanied with ChiariⅠmalformation(CMⅠ),the patients were divided into the CMⅠ-related SM group(CS group)and the idiopathic SM group(IS group);According to the size of SM,the patients were also divided into the big syrinx group(BS group,S/C>0.6)and the little syrinx group(LS group,S/C≤0.6).The contribution rates of preoperative traction and surgery to correction were statistically analyzed and compared between different groups(CS group vs IS group,BS group vs LS group).Results:The S/C ratio of SM in 40 patients was 0.59±0.18,with a length of 9.43±5.50 segments.Preoperative skull-femoral traction(SFT)was performed in 36 cases,and halo-gravity traction(HGT)in 4 cases.During traction,5 cases experienced temporary local numbness,2 cases had temporary local muscle weakness,and 5 cases developed traction nail tract infections.Low-grade osteotomy was performed in 2
作者
田小兵
谢维杰
解京明
王迎松
赵智
毕尼
李韬
施志约
TIAN Xiaobing;XIE Weijie;XIE Jingming(Department of Orthopaedics,the 2nd Affiliated Hospital of Kunming Medical University,Kunming,650101,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2024年第8期801-811,共11页
Chinese Journal of Spine and Spinal Cord
基金
国家自然科学基金(82260447,82060392)
云南省科技人才与平台计划(202205AF150009)
云南省基础研究计划面上项目(202101AT070241)。
关键词
脊柱侧凸
脊髓空洞症
牵引
外科矫形
Scoliosis
Syringomyelia
Traction
Surgical correction
