摘要
背景:半椎体畸形应早期手术治疗,然而半椎体切除术后畸形进展的危险因素尚无定论。目的:探讨经一期后路半椎体切除、椎弓根钉棒固定治疗先天性脊柱侧凸的疗效,进一步探索引起术后畸形进展的危险因素。方法:回顾性分析2012年1月至2020年2月因单一半椎体畸形行椎弓根钉棒固定治疗且随访时间至少2年的病例资料,最终共116例患者符合纳排标准。所有患者在术前、术后及各随访时间点拍摄站立位全脊柱正侧位X射线片,并测量节段侧凸角、总主弯侧凸角、近侧代偿弯角、远侧代偿弯角、冠状面平衡距离、顶椎偏距、上固定椎倾斜角、上固定椎间盘角、下固定椎倾斜角、下固定椎间盘角、节段后凸/前凸角、胸椎后凸角、腰椎前凸角以及矢状面平衡;并记录畸形进展及并发症情况。结果与结论:①患者术后节段侧凸角、总主弯侧凸角、节段后凸角、近端代偿弯角以及远端代偿弯角较术前明显矫正(P<0.05),并在末次随访时维持矫正;术前、术后及末次随访时胸椎后凸角、腰椎前凸角、冠状面平衡和矢状面平衡均在正常范围;②随访过程中,10例患者出现冠状面失代偿,表现为畸形进展;③独立样本t检验示术前总侧凸角、术前顶椎偏移、年龄、Risser征、术后上固定椎倾斜角及术后下固定椎倾斜角与术后畸形进展相关(P<0.05);④进一步多因素Logistic回归分析显示,术后下固定椎倾斜角是术后畸形进展的独立危险因素(P=0.002,OR=1.526);⑤通过受试者工作特征曲线分析发现:术后下固定椎倾斜角为8.14°是半椎体切除、椎弓根钉棒固定术后畸形进展的最佳阈值(敏感度为0.900,特异度为0.906,曲线下面积=0.926);⑥提示一期后路半椎体切除、椎弓根钉棒固定治疗先天性脊柱侧凸可达到满意的矫形效果;术后下固定椎倾斜角大于8.14°是术后冠状面失代偿的独立危险因素。
BACKGROUND:Hemivertebra deformity should be treated surgically at an early age,but the risk factors for progression of deformity after hemivertebral resection have not been established.OBJECTIVE:To investigate the curative effect of one-stage posterior hemivertebrae resection and pedicle screw fixation in the treatment of congenital scoliosis,and to further explore the risk factors causing the progression of postoperative deformity.METHODS:The medical records of patients who underwent pedicle screw-rod fixation for unilateral hemivertebral deformity from January 2012 to February 2020 and were followed up for at least 2 years were retrospectively analyzed,and a total of 116 patients met the inclusion criteria.All patients were treated with standing anterior and lateral spinal radiographs taken before,after and at each follow-up time point.The segment Cobb angle,the total scoliosis Cobb angle,the proximal complementary Cobb angle,the distal complementary Cobb angle,and the coronal balance distance,apical vertebra distance,upper instrumented vertebra tilt,upper instrumented vertebra disc angle,lower instrumented vertebra tilt,lower instrumented vertebra disc angle,segmental kyphosis/lordosis,thoracic kyphosis,lumbar lordosis and sagittal vertical axis were measured.The progression of deformity and complications were also recorded.RESULTS AND CONCLUSION:(1)Segment Cobb,total scoliosis Cobb,segmental kyphosis,proximal complementary Cobb,and distal complementary Cobb were significantly corrected after operation(P<0.05),and remained corrected at the last follow-up.Thoracic kyphosis,lumbar lordosis,coronal balance distance,and sagittal vertical axis were all in the normal range pre-operation,after operation and at the last follow-up.(2)During follow-up,10 patients developed coronary decompensation,which was characterized by abnormal progression.(3)Independent sample t-test showed that preoperative total scoliosis Cobb,preoperative apical vertebra distance,age,Risser sign,postoperative upper instrument vertebra tilt and postoperative lowest instrumented vertebra tilt were correlated with postoperative malformation progression(P<0.05).(4)Multivariate Logistic regression analysis showed that postoperative lowest instrumented vertebra tilt was an independent risk factor for postoperative malformation progression(P=0.002,OR=1.526).(5)Receiver operating characteristic curve analysis showed that a postoperative lowest instrumented vertebra tilt of 8.14°was the optimal threshold for deformity progression after hemivertebrae resection and pedicle rod fixation(sensitivity 0.900,specificity 0.906,area under curve:0.926).(6)It is indicated that the treatment of congenital scoliosis with one-stage posterior hemivertebrae resection and pedicle nail fixation can achieve satisfactory orthopedic effect.Postoperative lowest instrumented vertebra tilt greater than 8.14°was an independent risk factor for postoperative coronal decompensation.
作者
杨万忠
马荣
郭伟
王志强
杨伟
陈振
王泽民
张弘来
戈朝晖
Yang Wanzhong;Ma Rong;Guo Wei;Wang Zhiqiang;Yang Wei;Chen Zhen;Wang Zemin;Zhang Honglai;Ge Zhaohui(First Clinical Medical School of Ningxia Medical University,Yinchuan 750001,Ningxia Hui Autonomous Region,China;Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China)
出处
《中国组织工程研究》
北大核心
2025年第33期7173-7180,共8页
Chinese Journal of Tissue Engineering Research
基金
2023宁夏重点研发计划项目(2023BEG02017),项目负责人:戈朝晖
2021宁夏重点研发计划项目(2022BEG03087),项目负责人:马荣
宁夏医科大学总医院医工专项项目(NYZYYG-005),项目负责人:戈朝晖。
关键词
先天性脊柱侧凸
半椎体切除
内固定
随访
畸形进展
骨科植入物
congenital scoliosis
hemivertebra resection
internal fixation
follow-up
deformity progression
orthopedic implants
