CAJ | 학술논문

目的分析经椎弓根不对称截骨( asymmetrical pedicle subtraction osteotomy，APSO )治疗伴躯干失平衡的退变性腰椎侧后凸畸形的矫形疗效。方法2008年2月至2012年5月，因退变性腰椎侧后凸畸形而入我院行手术治疗的11例中老年患者，男4例，女7例，年龄52～76岁，平均64.8岁，随访时间均＞1年。所有患者均行后路经椎弓根不对称截骨、椎弓根螺钉内固定植骨融合术。在术前、术后站立位全脊柱正、侧位X线片上测量患者冠、矢状面脊柱畸形及躯干平衡的影像学参数，评价矫形效果，并应用SRS-22问卷及VAS疼痛评分评价临床疗效。结果所有患者均安全接受手术，手术时间3.2～6.5 h，平均4.1 h，术中出血量780～3400 ml，平均1280 ml。冠状面Cobb’s角由术前43.1°矫正至术后24.1°，矫正率44.1%；冠状面躯干偏移( central sacral vertical line，CSVL )由3.8 cm矫正至1.1 cm。矢状面后凸角由43.2°矫正至15.4°，矫正率64.4%；矢状面平衡距离( sagittal vertical axis，SVA )由6.2 cm矫正至1.2 cm，以上所有指标均较术前改善显著( P＜0.01)。SRS-22量表术后总分及各维度评分较术前增高显著(68.1±8.9 vs 61.3±7.5，P＜0.01)。VAS评分由(6.6±1.8)分减少到(2.1±1.5)分( P＜0.01)。所有患者术后无严重神经血管损伤、术后感染等并发症发生。结论 APSO可以同时有效矫正退变性脊柱侧后凸患者躯干冠状面和矢状面的失平衡，可以显著改善患者的生活质量，缓解疼痛，是一种安全有效的矫形手术。
목적분석경추궁근불대칭절골( asymmetrical pedicle subtraction osteotomy，APSO )치료반구간실평형적퇴변성요추측후철기형적교형료효。방법2008년2월지2012년5월，인퇴변성요추측후철기형이입아원행수술치료적11례중노년환자，남4례，녀7례，년령52～76세，평균64.8세，수방시간균＞1년。소유환자균행후로경추궁근불대칭절골、추궁근라정내고정식골융합술。재술전、술후참립위전척주정、측위X선편상측량환자관、시상면척주기형급구간평형적영상학삼수，평개교형효과，병응용SRS-22문권급VAS동통평분평개림상료효。결과소유환자균안전접수수술，수술시간3.2～6.5 h，평균4.1 h，술중출혈량780～3400 ml，평균1280 ml。관상면Cobb’s각유술전43.1°교정지술후24.1°，교정솔44.1%；관상면구간편이( central sacral vertical line，CSVL )유3.8 cm교정지1.1 cm。시상면후철각유43.2°교정지15.4°，교정솔64.4%；시상면평형거리( sagittal vertical axis，SVA )유6.2 cm교정지1.2 cm，이상소유지표균교술전개선현저( P＜0.01)。SRS-22량표술후총분급각유도평분교술전증고현저(68.1±8.9 vs 61.3±7.5，P＜0.01)。VAS평분유(6.6±1.8)분감소도(2.1±1.5)분( P＜0.01)。소유환자술후무엄중신경혈관손상、술후감염등병발증발생。결론 APSO가이동시유효교정퇴변성척주측후철환자구간관상면화시상면적실평형，가이현저개선환자적생활질량，완해동통，시일충안전유효적교형수술。
Objective To investigate the orthopedic effects of asymmetrical pedicle subtraction osteotomy ( APSO ) in the treatment of degenerative lumbar kyphoscoliosis with concomitant trunk imbalance. Methods From February 2008 to May 2012, 11 middle-aged and elderly patients with degenerative lumbar kyphoscoliosis were adopted and underwent surgical treatment in our hospital. There were 4 males and 7 females, whose mean age was 64.8 years old ( range;52-76 years ). They were followed up for more than 1 year. All patients underwent posterior APSO, pedicle screwinternal fixation and bone graft fusion. Radiographic parameters including the coronal and sagittal spinal deformity and trunk balance were measured to evaluate the orthopedic effects based on the whole-spine anteroposterior and lateral X-ray iflms in the erect position preoperatively and postoperatively. The Scoliosis Research Society-22 ( SRS-22 ) Questionnaire and the Visual Analogue Scale ( VAS ) were used to evaluate outcomes. Results Operations were safely performed on all the patients. The average operation time was 4.1 hours ( range;3.2-6.5 hours ), while the average blood loss during the surgery was 1280 ml ( range;780-3400 ml ). The coronal Cobb’s angle was improved from 43.1° preoperatively to 24.1° postoperatively, and the correction rate was 44.1%. The central sacral vertical line ( CSVL ) was improved from 3.8 cm to 1.1 cm. The mean sagittal kyphosis was improved from 43.2° to 15.4°, and the correction rate was 64.4%. The sagittal vertical axis ( SVA ) was improved from 6.2 cm to 1.2 cm. All the parameters stated above were signiifcantly improved postoperatively when compared with those preoperatively. In addition, the SRS-22 total scores and scores in each dimension were signiifcantly improved ( 68.1±8.9 point vs. 61.3±7.5 points, P<0.01 ), and the VAS score was decreased from ( 6.6±1.8 ) points to ( 2.1±1.5 ) points ( P<0.01 ). No complications such as severe neurovascular injury or infection occurred postoperatively. Conclusions APSO <br> caneffectively restore the coronal balance and sagittal balance of the trunkat the same time, improve the life quality and relieve pain for the patients with degenerative lumbar kyphoscoliosis. This surgical procedure is safe and effective.