CAJ | 학술논문

目的探讨严重脊柱畸形三柱截骨术中围截骨区卫星棒技术的可行性,并评估其临床应用价值.方法回顾性分析2012年7月至2014年1月期间应用卫星棒技术行严重脊柱畸形三柱截骨并有完整临床及影像学资料的13例患者,男6例,女7例;年龄12～57岁,平均(30.9±19.1)岁.分别测量患者手术前后及末次随访时侧凸Cobb角、最大后凸Cobb角(global kyphosis,GK)、冠状面平衡(distance betweenC7 plumb line and center sacral vertical line,C7PL-CSVL)和矢状面平衡(sagittal vertical axis,SVA).患者初诊及每次随访均填写SF-36量表.结果随访时间平均为(15.8±3.8)个月.术前侧凸Cobb角平均为86.3°±22.6°,术后为45.2°±19.7°,较术前明显改善,平均矫正率为47.7％±19.1％;末次随访为39.9°±19.8°,随访期间未见明显矫正丢失.术前GK为80.9°±18.7°,术后为35.1°±14.5°,平均矫正率为57.8％±13.8％;末次随访时未见明显丢失,平均为36.3°±10.0°.手术前后C7PL-CSVL分别为(43.7±36.8) mm、(18.8±5.6) mm,术后有明显改善;末次随访时维持良好,平均为(19.2±8.3)mm.SVA由术前平均(55.0±51.5)mm减小至术后(29.3±19.5)mm,末次随访为(34.2±17.5) mm,亦无明显矫正丢失.13例患者术中监测均无信号异常.术后1例患者1枚螺钉位置偏上穿出上终板,1例患者1枚螺钉位置偏外.患者随访期间均无明显矫形丢失及断钉、断棒等内固定并发症.结论严重脊柱畸形三柱截骨引入卫星棒技术既满足坚强固定需要又起到分散应力作用,术后矫形效果满意,随访期间矫正丢失及内固定失败等并发症少.
목적 탐토엄중척주기형삼주절골술중위절골구위성봉기술적가행성,병평고기림상응용개치.방법 회고성분석2012년7월지2014년1월기간응용위성봉기술행엄중척주기형삼주절골병유완정림상급영상학자료적13례환자,남6례,녀7례;년령12～57세,평균(30.9±19.1)세.분별측량환자수술전후급말차수방시측철Cobb각、최대후철Cobb각(global kyphosis,GK)、관상면평형(distance betweenC7 plumb line and center sacral vertical line,C7PL-CSVL)화시상면평형(sagittal vertical axis,SVA).환자초진급매차수방균전사SF-36량표.결과 수방시간평균위(15.8±3.8)개월.술전측철Cobb각평균위86.3°±22.6°,술후위45.2°±19.7°,교술전명현개선,평균교정솔위47.7％±19.1％;말차수방위39.9°±19.8°,수방기간미견명현교정주실.술전GK위80.9°±18.7°,술후위35.1°±14.5°,평균교정솔위57.8％±13.8％;말차수방시미견명현주실,평균위36.3°±10.0°.수술전후C7PL-CSVL분별위(43.7±36.8) mm、(18.8±5.6) mm,술후유명현개선;말차수방시유지량호,평균위(19.2±8.3)mm.SVA유술전평균(55.0±51.5)mm감소지술후(29.3±19.5)mm,말차수방위(34.2±17.5) mm,역무명현교정주실.13례환자술중감측균무신호이상.술후1례환자1매라정위치편상천출상종판,1례환자1매라정위치편외.환자수방기간균무명현교형주실급단정、단봉등내고정병발증.결론 엄중척주기형삼주절골인입위성봉기술기만족견강고정수요우기도분산응력작용,술후교형효과만의,수방기간교정주실급내고정실패등병발증소.
Objective To evaluate the feasibility and clinical outcomes of satellite rod technique utilized in severe spinal deformity undergoing three-column osteotomy.Methods Thirteen patients (6 males and 7 females) with an average age of 30.9± 19.1 years from July 2012 to January 2014 were retrospectively reviewed.The coronal parameters including Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL),as well as the sagittal parameters including global kyphosis (GK) and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and at last follow-up.The Short Form36 Health Survey (SF-36) was fulfilled at pre-operation and each follow-up.The paired t test was used to analyze the differences among pre-operation,post-operation and last follow-up.Results The average follow-up period was 15.8±3.8 months.The pre-operative and post-operative Cobb angles were 86.3°±22.6° and 45.2°± 19.7°.The correction rate of Cobb angle was 47.7％±19.1％.At the last follow-up,the average Cobb angle was 39.9°± 19.8° with no significant loss of correction.The pre-operative,post-operative and last follow-up C7PL-CSVL were 43.7±36.8 mm,18.8±5.6 mm and 19.2±8.3 mm,respectively.Significant post-operative improvement was observed while there was no change at last follow-up.Post-operative GK significantly improved from 80.9°±18.7°to 35.1°±14.5° with the correction rate of 57.8％±13.8％.SVA decreased significantly from 55.0±51.5 mm to 29.3±19.5 mm.The average GK and SVA at last follow-up were 36.3°± 10.0° and 34.2± 17.5 mm,and no loss of correction was found.In addition,no change or loss of motor or somatosensory evoked potential occurred during surgery.In spite of two malposition screws,no other complications of implant failure were found during follow-up.Conclusion The satellite rod used in patients with severe spinal deformity undergoing three-column osteotomy could disperse stress of each rod and get satisfied clinical outcomes.With the utilization of satellite rod technique,the coronal and sagittal balance could be well maintained during follow-up.