• 解放軍第306 醫(yī)院全軍脊柱外科中心（北京，100101）;

目的 探討對(duì)于中重度脊柱側(cè)后凸畸形，采用經(jīng)椎弓根截骨（pedicle subtraction osteotomy，PSO）技術(shù)和非截骨技術(shù)治療的臨床效果。 方法 2005 年1 月－ 2009 年1 月，對(duì)99 例中重度脊柱側(cè)后凸畸形患者分別采用PSO截骨（PSO 截骨組，46 例）和非截骨技術(shù)（非截骨組，53 例）行后路矯形治療。兩組患者性別、年齡、術(shù)前主側(cè)凸Cobb 角、胸腰段后凸Cobb 角等一般資料比較差異無統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），有可比性。分別記錄兩組手術(shù)時(shí)間、出血量，術(shù)后測(cè)量脊柱主側(cè)凸Cobb 角、胸腰段后凸Cobb 角，并計(jì)算側(cè)凸和后凸矯正率以及末次隨訪的矯正率丟失。 結(jié)果 患者均順利完成手術(shù)。PSO 截骨組患者手術(shù)時(shí)間和出血量均多于非截骨組，比較差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。所有患者均獲隨訪，隨訪時(shí)間12 ～ 56 個(gè)月，平均22.4 個(gè)月。兩組均未出現(xiàn)脊髓神經(jīng)損傷，末次隨訪時(shí)均獲得良好的骨性融合。兩組患者術(shù)后2 周及末次隨訪時(shí)的主側(cè)凸Cobb 角及胸腰段后凸Cobb 角均較術(shù)前顯著改善（P  lt; 0.05）。術(shù)后2 個(gè)時(shí)間點(diǎn)的主側(cè)凸Cobb 角、矯正率兩組間比較差異均無統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）；但PSO 截骨組末次隨訪時(shí)的矯正率丟失明顯小于非截骨組（P  lt; 0.05）。術(shù)后2 個(gè)時(shí)間點(diǎn)的胸腰段后凸Cobb 角、矯正率及矯正率丟失，PSO 截骨組均優(yōu)于非截骨組，差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。 結(jié)論 對(duì)于中重度脊柱側(cè)后凸畸形，PSO 截骨技術(shù)較非截骨技術(shù)在冠狀面?zhèn)韧沟某C形方面無顯著差異，但能夠獲得更好的脊柱矢狀面后凸矯形效果；但PSO 截骨的手術(shù)時(shí)間和出血量會(huì)顯著增加。

引用本文： 周建偉,彭晉升,楊濱,牛晶,陳志明,王曉平,李佳,馬華松. 經(jīng)椎弓根截骨與非截骨技術(shù)治療中重度脊柱側(cè)后凸的臨床研究. 中國(guó)修復(fù)重建外科雜志, 2012, 26(4): 406-410. doi: 復(fù)制

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1. Heining CF. Eggshell procedure//Luque ER, eds. Segmental Spinal Instrumentation. Thorofare, New Jersey: Slack, 1984: 221-234.
2. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
3. Halm H. Pedicle subtraction osteotomy for correction of congenital scoliokyphosis. Eur Spine J, 2011, 20(6): 995-996.
4. Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
5. Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine (Phila Pa 1976), 2009, 34(14): 1504-1512.
6. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50.
7. 劉濤, 馬華松, 周建偉, 等. 經(jīng)椎弓根截骨凸側(cè)懸臂梁技術(shù)治療重度僵硬性先天性脊柱側(cè)后凸. 中國(guó)骨腫瘤骨病雜志, 2011, 10(5): 355-359.
8. 陳志明, 馬華松, 譚榮, 等. 重度僵硬后凸型脊柱側(cè)凸畸形的手術(shù)治療. 中國(guó)骨與關(guān)節(jié)外科, 2011, 4(1): 27-31.
9. 馬華松, 周建偉, 鄒德威, 等. 重度僵硬型脊柱側(cè)凸的后路非全椎體截骨手術(shù)治療. 中國(guó)矯形外科雜志, 2010, 18(16): 1323-1326.
10. 張宏其, 魯世金, 陳靜, 等. 廣泛后路松解三維矯形治療重度特發(fā)性脊柱側(cè)凸. 中國(guó)脊柱脊髓雜志, 2007, 17(4): 274-279.
11. Burton DC, Sama AA, Asher MA, et al. The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine (Phila Pa 1976), 2005, 30(17): 1979-1984.
12. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2038.
13. Kim KT, Park KJ, Lee JH. Osteotomy of the spine to correct the spinal deformity. Asian Spine J, 2009, 3(2): 113-123.
14. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-178.
15. Hyun SJ, Rhim SC. Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc, 2010, 47(2): 95-101.
16. Heary RF, Albert TJ. 脊柱畸形精要. 李明, 王巖, 陳仲強(qiáng), 等譯. 上海: 上?？茖W(xué)技術(shù)出版社, 2009: 67-68.
17. 鄒德威, 譚榮. 三柱截骨治療重度僵硬性脊柱側(cè)凸的手術(shù)決策和風(fēng)險(xiǎn)規(guī)避. 中華外科雜志, 2010, 48(11): 1691-1693.
18. Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
19. Baldus CR, Bridwell KH, Lenke LG, et al. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine (Phila Pa 1976), 2010, 35(2): 235-239.
20. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
21. Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between smith-petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2011. [Epub ahead of print].
  1. 1. Heining CF. Eggshell procedure//Luque ER, eds. Segmental Spinal Instrumentation. Thorofare, New Jersey: Slack, 1984: 221-234.
  2. 2. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
  3. 3. Halm H. Pedicle subtraction osteotomy for correction of congenital scoliokyphosis. Eur Spine J, 2011, 20(6): 995-996.
  4. 4. Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
  5. 5. Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine (Phila Pa 1976), 2009, 34(14): 1504-1512.
  6. 6. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50.
  7. 7. 劉濤, 馬華松, 周建偉, 等. 經(jīng)椎弓根截骨凸側(cè)懸臂梁技術(shù)治療重度僵硬性先天性脊柱側(cè)后凸. 中國(guó)骨腫瘤骨病雜志, 2011, 10(5): 355-359.
  8. 8. 陳志明, 馬華松, 譚榮, 等. 重度僵硬后凸型脊柱側(cè)凸畸形的手術(shù)治療. 中國(guó)骨與關(guān)節(jié)外科, 2011, 4(1): 27-31.
  9. 9. 馬華松, 周建偉, 鄒德威, 等. 重度僵硬型脊柱側(cè)凸的后路非全椎體截骨手術(shù)治療. 中國(guó)矯形外科雜志, 2010, 18(16): 1323-1326.
  10. 10. 張宏其, 魯世金, 陳靜, 等. 廣泛后路松解三維矯形治療重度特發(fā)性脊柱側(cè)凸. 中國(guó)脊柱脊髓雜志, 2007, 17(4): 274-279.
  11. 11. Burton DC, Sama AA, Asher MA, et al. The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine (Phila Pa 1976), 2005, 30(17): 1979-1984.
  12. 12. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2038.
  13. 13. Kim KT, Park KJ, Lee JH. Osteotomy of the spine to correct the spinal deformity. Asian Spine J, 2009, 3(2): 113-123.
  14. 14. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-178.
  15. 15. Hyun SJ, Rhim SC. Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc, 2010, 47(2): 95-101.
  16. 16. Heary RF, Albert TJ. 脊柱畸形精要. 李明, 王巖, 陳仲強(qiáng), 等譯. 上海: 上海科學(xué)技術(shù)出版社, 2009: 67-68.
  17. 17. 鄒德威, 譚榮. 三柱截骨治療重度僵硬性脊柱側(cè)凸的手術(shù)決策和風(fēng)險(xiǎn)規(guī)避. 中華外科雜志, 2010, 48(11): 1691-1693.
  18. 18. Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
  19. 19. Baldus CR, Bridwell KH, Lenke LG, et al. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine (Phila Pa 1976), 2010, 35(2): 235-239.
  20. 20. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
  21. 21. Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between smith-petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2011. [Epub ahead of print].