CAJ | 학술논문

目的：比较后路脊柱截骨术和牵引辅助后路广泛松解术治疗重度脊柱畸形的围手术期并发症和初步疗效。方法回顾性比较研究我科收治的29例重度脊柱畸形患者资料。2013年8月至2014年6月，行牵引辅助后路广泛松解术矫形患者(牵引组)12例；2012年6月至2013年8月，行后路脊柱截骨手术矫形患者(对照组)17例。牵引组术前主弯Cobb’s角平均为111.8°，对照组平均为115.2°；牵引组术前最大后凸角度平均为113.3°，对照组为118.5°。比较两组间术后90天内的并发症发生率以及临床疗效。结果两组术前平均年龄、性别比、体重指数、主弯角度、主弯柔韧度、最大后凸角差异无统计学意义。手术时间，牵引组和对照组分别为(322.1±102.5)min和(426.3±100.4)min(P＝0.012)；术中出血量，牵引组和对照组分别为(1241.7±999.5)ml和(2300.0±1449.1)ml(P＝0.040)；置钉密度，牵引组和对照组分别为(58.0±16.2)%和(77.4±13.1)%(P＝0.001)；而围手术期并发症，牵引组和对照组分别为16.7%和58.8%(P＝0.049)；两组比较，牵引组显著小于对照组，差异有统计学意义，但两组的畸形矫正率相当。结论重度脊柱畸形患者的后路脊柱截骨术和牵引辅助后路广泛松解术，疗效相当，但牵引辅助后路广泛松解术，可避免侵袭性大的操作、缩短手术时间、减少出血量，并显著减少了围手术期并发症的发生率。
목적：비교후로척주절골술화견인보조후로엄범송해술치료중도척주기형적위수술기병발증화초보료효。방법회고성비교연구아과수치적29례중도척주기형환자자료。2013년8월지2014년6월，행견인보조후로엄범송해술교형환자(견인조)12례；2012년6월지2013년8월，행후로척주절골수술교형환자(대조조)17례。견인조술전주만Cobb’s각평균위111.8°，대조조평균위115.2°；견인조술전최대후철각도평균위113.3°，대조조위118.5°。비교량조간술후90천내적병발증발생솔이급림상료효。결과량조술전평균년령、성별비、체중지수、주만각도、주만유인도、최대후철각차이무통계학의의。수술시간，견인조화대조조분별위(322.1±102.5)min화(426.3±100.4)min(P＝0.012)；술중출혈량，견인조화대조조분별위(1241.7±999.5)ml화(2300.0±1449.1)ml(P＝0.040)；치정밀도，견인조화대조조분별위(58.0±16.2)%화(77.4±13.1)%(P＝0.001)；이위수술기병발증，견인조화대조조분별위16.7%화58.8%(P＝0.049)；량조비교，견인조현저소우대조조，차이유통계학의의，단량조적기형교정솔상당。결론중도척주기형환자적후로척주절골술화견인보조후로엄범송해술，료효상당，단견인보조후로엄범송해술，가피면침습성대적조작、축단수술시간、감소출혈량，병현저감소료위수술기병발증적발생솔。
Objective To compare the perioperative complications and clinical outcomes of posterior spinal osteotomy and Halo traction with wide posterior release for severe spinal deformity. Methods Records of 29 patients with severe spinal deformity treated in our hospital were examined. Twelve were treated by wide posterior release with traction from August 2013 to June 2014(Traction Group), and 17 were treated with posterior spinal osteotomy from June 2012 to August 2013(Control Group ). The average preoperative main curve for Traction Group was 111.8° and for Control Group was 115.2°. The average preoperative maximal kyphosis for Traction Group was 113.3° and for Control Group was 118.5°. Radiographic and clinical outcomes were compared between groups. Results A t test demonstrated that the differences between the groups in age, sex, body mass index(BMI), preoperative main curve and maximal kyphosis, and preoperative main curve lfexibility were not statistically signiifcant. The postoperative deformity correction was comparable, however, the Traction Group had a statistically significant decrease in operative time [(322.1±102.5 ) min vs.(426.3±100.4 ) min, P=0.012 ], blood loss [(1241.7±999.5 ) ml vs.(2300.0±1449.1 ) ml, P=0.040 ], implant density [(58.0±16.2 )%vs.(77.4±13.1 )%, P=0.001 ] and total complication rate(16.7%vs. 58.8%, P=0.049 ). Conclusions Study shows that effects of posterior spinal osteotomy and Halo traction with wide posterior release for severe spinal deformity are similar. However, Halo traction with wide posterior release can avoid aggressive procedures, reduce operation time, blood loss, and perioperative complications.