CAJ | 학술논문

研究设计回顾性比较研究。目的评估单纯后路椎弓根螺钉内固定治疗侧凸角度＞90°的重度脊柱畸形的疗效和安全性。研究背景对于侧凸角度＞90°的重度脊柱畸形的标准手术方式仍存争议，传统术式包括围手术期牵引辅助和分期前后路联合手术。方法回顾性分析由同一术者采取单纯后路椎弓根螺钉内固定治疗的40例侧凸角度＞90°的重度脊柱畸形患者资料，侧凸角度平均为111.4°(91～175)°，平均随访31(6～60)个月。其中特发性脊柱侧凸27例，先天性9例，神经肌肉型3例，症状性1例。40例中，25例行多节段Ponte截骨术联合后路椎弓根螺钉内固定术，另15例则行全脊椎切除联合后路椎弓根螺钉内固定术。分析影像学结果和并发症发生率。结果影像学结果表明，单纯后路椎弓根螺钉矫形术可使主弯平均矫正率术后8周达49%，而末次随访时为47%(P＜0.001)。总畸形角度(主弯Cobb’s角＋最大后凸角)术前平均为160°，而术后8周和末次随访时，平均矫正率分别为50%和48%(P＜0.001)。有7例(18%)术中运动诱发电位(motorevokedpotential，MEP)消失，而4例(10%)术后出现暂时性脊髓神经损伤。1例术后并发伤口感染。另1例术后2年随访时发现内植物断裂，予以观察随访。结论单纯后路椎弓根螺钉内固定可有效治疗角度＞90°的重度脊柱侧凸，其可避免前路手术或围手术期牵引，达到理想的矫形效果，且无严重并发症。
연구설계회고성비교연구。목적평고단순후로추궁근라정내고정치료측철각도＞90°적중도척주기형적료효화안전성。연구배경대우측철각도＞90°적중도척주기형적표준수술방식잉존쟁의，전통술식포괄위수술기견인보조화분기전후로연합수술。방법회고성분석유동일술자채취단순후로추궁근라정내고정치료적40례측철각도＞90°적중도척주기형환자자료，측철각도평균위111.4°(91～175)°，평균수방31(6～60)개월。기중특발성척주측철27례，선천성9례，신경기육형3례，증상성1례。40례중，25례행다절단Ponte절골술연합후로추궁근라정내고정술，령15례칙행전척추절제연합후로추궁근라정내고정술。분석영상학결과화병발증발생솔。결과영상학결과표명，단순후로추궁근라정교형술가사주만평균교정솔술후8주체49%，이말차수방시위47%(P＜0.001)。총기형각도(주만Cobb’s각＋최대후철각)술전평균위160°，이술후8주화말차수방시，평균교정솔분별위50%화48%(P＜0.001)。유7례(18%)술중운동유발전위(motorevokedpotential，MEP)소실，이4례(10%)술후출현잠시성척수신경손상。1례술후병발상구감염。령1례술후2년수방시발현내식물단렬，여이관찰수방。결론단순후로추궁근라정내고정가유효치료각도＞90°적중도척주측철，기가피면전로수술혹위수술기견인，체도이상적교형효과，차무엄중병발증。
Study design A retrospective comparative study. Objective To assess the efifcacy and safety of posterior only pedicle screw construct ( POPS ) for the treatment of scoliotic curves>90 degrees using radiographic outcomes and various clinical outcomes. Summary of Background Data A paucity of data exists regarding standardized surgical options for severe scoliotic curvatures > 90°. Perioperative traction or staged anterior and posterior operations were the traditional surgical options. Methods A total of 40 consecutive scoliosis patients with curves>90° ( average 111.4°;range 91°-175° ) with an ( average follow-up of 31 months;range 6-60 months ) who underwent spinal instrumented fusion with posterior only pedicle screw constructs performed by a single surgeon were analyzed. Diagnoses included idiopathic scoliosis ( n=27 ), congenital ( n=9 ), neuromuscular ( n=3 ), and syndromic ( n=1 ). In total, 25 patients were treated with posterior only pedicle screw constructs with multiple Ponte ostotomies while the other 15 patients with posterior vertebral column resection. Radiographic examinations and complications were analyzed. Results Radiographic outcomes demonstrated an average major curve correction of 49%and 47%at eight weeks post operation and final follow-up respectively ( P<0.001 ). Total deformity angle, major Cobb’s angle+maximal kyphosis with an average of 160 degrees preoperatively, showed an average correction of 50%and 48%at eight weeks post operation and ifnal follow-up respectively ( P<0.001 ). There were seven cases ( 18%) of intraoperative MEP ( motor evoked potential ) loss and four patients ( 10%) with transient spinal cord deifcit. One patient developed postoperative infection. Another patient had a unilateral broken rod in two years follow-up which was treated with observation. Conclusions Scoliosis patients with curve>90 degree can be managed successfully by posterior only pedicle screw construct ( POPS ). POPS avoids the need for anterior surgical procedures or perioperative traction while achieving acceptable correction safely without signiifcant complication.