| Ⅰ期三柱截骨矫形术治疗脊柱侧凸伴脊髓纵裂 |
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投稿时间：2019-09-06
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| 作者 | Author | 单位 | Address | E-Mail |
| 王新浩 |
WANG Xin-hao |
南阳市南石医院, 河南 南阳 473000 |
Nanshi Hospital of Nanyang City, Nanyang 473000, Henan, China |
529994407@qq.com |
| 郑伟 |
ZHENG Wei |
南阳市南石医院, 河南 南阳 473000 |
Nanshi Hospital of Nanyang City, Nanyang 473000, Henan, China |
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| 陈建光 |
CHEN Jian-guang |
南阳市第一人民医院, 河南 南阳 473000 |
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| 苗吉显 |
MIAO Ji-xian |
河南省骨科医院, 河南 郑州 450000 |
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| 李凤春 |
LI Feng-chun |
洛阳正骨医院, 河南 洛阳 471000 |
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| 期刊信息：《中国骨伤》2020年，第33卷，第2期，第131-135页 |
| DOI：10.12200/j.issn.1003-0034.2020.02.008 |
| 基金项目: |
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中文摘要:
目的：分析Ⅰ期三柱截骨矫形术用于脊柱侧凸伴脊髓纵裂的有效性及安全性。
方法：对2015年1月至2017年12月接受Ⅰ期三柱截骨矫形术治疗的41例脊柱侧凸伴脊髓纵裂患者进行回顾性分析，其中男17例，女24例；年龄（25.14±4.51）岁；体重（65.14±9.11）kg。根据脊髓纵裂的分型进行分组，15例PangⅠ型纵裂为A组，26例PangⅡ型纵裂为B组。记录两组患者的一般情况；观察两组患者手术前后的Cobb角并计算冠状面Cobb角矫正率；术后对两组患者冠状位与矢状位躯干偏移距离进行比较，评价其躯干平衡性；记录两组患者并发症发生情况。
结果：术后41例患者均获得12个月以上的随访。A组手术时间、术中失血量、围手术期输血量分别（610.14±115.02）min、（4 001.12±1 014.33）ml、（3 951.14±1 021.55）ml，B组分别为（520.12±101.14）min、（2 701.57±1 021.45）ml、（2 565.77±880.47）ml，两组差异有统计学意义（P<0.05）；A、B两组术后住院时间分别为（9.45±4.21）d和（9.14±3.01）d，差异无统计学意义（P>0.05）。术后冠状面Cobb角及矫正率比较，两组差异无统计学意义（P>0.05）；术后即刻、术后12个月，两组冠状位躯干偏移距离、矢状位躯干偏移距离比较，差异均无统计学意义（P>0.05）；A组术后6例患者有并发症发生，高于B组的1例（χ2=4.885，P<0.05）。
结论：Ⅰ期三柱截骨矫形术用于脊柱侧凸伴脊髓纵裂的治疗，矫正率高，患者躯干稳定性好。但对于Ⅰ类纵裂患者而言，手术时间较长、术中失血量多，围术期需大量输血，且并发症风险高，安全性不及Ⅱ类患者，故在脊柱侧凸的实际治疗中，特别是对于伴Ⅰ类脊髓纵裂者，还应结合患者实际情况为其制定更为合理的手术方案，以提高手术安全性。 |
| 【关键词】脊柱侧凸 脊髓纵裂 Ⅰ期三柱截骨术 Cobb角 |
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| One-stage three-column osteotomy for the treatment of scoliosis with split spinal cord malformation |
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ABSTRACT
Objective: To analyze the effectiveness and safety of one-stage three-column osteotomy in treatment of scoliosis with split spinal cord malformation.
Methods: The clinical data of 41 patients with scoliosis and split spinal cord malformation underwent one-stage three-column osteotomy from January 2015 to December 2017 were retrospectively analyzed. There were 17 males and 24 females with average age of(25.14±4.51) years old and the average weight of(65.14±9.11) kg. According to the classification of longitudinal spina bifida,15 cases of Pang typeⅠwere group A and 26 cases of Pang typeⅡwere group B. The general situations of two groups were recorded;preoperative and postoperative Cobb angle were observed and the correction rate of Cobb angle of coronal plane was calculated;the coronal and sagittal torso offset distances were compared between two groups and the trunk balance was evaluated; the complication of two groups was recorded.
Results: All 41 patients were followed up for more than 12 months. The operation time,intraoperative blood loss,and perioperative blood transfusion volume in group A were (610.14±115.02) min,(4 001.12±1 014.33) ml,(3 951.14±1 021.55) ml,respectively,and group B were(520.12±101.14) min,(2 701.57±1 021.45) ml,(2 565.77±880.47) ml,the difference between the two groups was statistically significant(P<0.05). The postoperative hospital stays in the group A and B were (9.45±4.21) days and (9.14±3.01) days,respectively,and there was no significant difference(P>0.05). There was no significant difference in postoperative coronary Cobb angle and correction rate between two groups (P>0.05). Immediately after surgery and 12 months after surgery,there was no significant difference in the trunk displacement distance of coronal view and sagittal view between two groups (P>0.05). Six patients in group A had complications,which was higher than that in group B of 1 case (χ2=4.885,P<0.05).
Conclusion: One-stage three-column osteotomy in treatment of scoliosis with split spinal cord malformation has high correction rate and good balance of the trunk. However,for patients with typeⅠsplit spinal cord malformation,they will face longer operation time,more intraoperative bleeding volume,large amount of perioperative blood transfusion and higher risk of complications,and the safety is not as good as that of typeⅡpatients. Therefore,in the actual treatment of scoliosis,especially for those with typeⅠsplit spinal cord malformation,a more reasonable surgical plan should be developed in combination with the actual situations of the patients,so as to improve the safety of the operation. |
| KEY WORDS Scoliosis Split spinal cord malformation One-stage three-column osteotomy Cobb angle |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王新浩,郑伟,陈建光,苗吉显,李凤春.Ⅰ期三柱截骨矫形术治疗脊柱侧凸伴脊髓纵裂[J].中国骨伤,2020,33(2):131~135 |
| 英文格式: | WANG Xin-hao,ZHENG Wei,CHEN Jian-guang,MIAO Ji-xian,LI Feng-chun.One-stage three-column osteotomy for the treatment of scoliosis with split spinal cord malformation[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(2):131~135 |
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