成人僵硬性退变性脊柱侧凸的截骨方式的选择

发布时间：2018-05-11 18:41

本文选题：腰椎 + 退变　；参考：《新疆医科大学》2015年硕士论文

【摘要】：目的：探讨成人僵硬性退变性脊柱侧凸的的影像学特征及截骨方式选择。方法：收集我院于2011年1月至2014年9月收治的45例僵硬性成人退变性脊柱侧凸行长节段固定截骨矫形的完整病例资料,按照截骨方式分为两组。SPO组28例,男8例,女20例,年龄51～75岁,平均61.1岁,心血管疾病17例,呼吸系统疾病5例,糖尿病11例；PSO组17例,男6例,女11例,年龄50～73岁,平均62.5岁,心血管疾病6例,呼吸系统疾病3例,糖尿病7例。根据术前全脊柱X片、Bending像及CT三维重建判断脊柱僵硬性及僵硬来源,选择截骨方式,SPO或PSO,分析两组术前及末次随访的脊柱影像学指标及疗效结果。结果：45例患者手术均顺利完成,无死亡病例,术后随访6-45月,平均22.4月。两组术前及末次随访的ODI及VAS评分有明显统计学意义(P0.05),SPO组Cobb角改善率为69.33%,PSO组Cobb角改善率为76.14%,两组重新获得了脊柱冠矢状面平衡,两种截骨方式均取得良好的临床疗效。SPO组,手术时间155-290min,平均213min,出血量700-1550ml,平均1253m1,脑脊液漏5例,感染1例,内固定松动1例；PSO组,手术时间160-320min,平均264min,出血量900-2200m1,平均1756m1,脑脊液漏4例,感染1例,无内固定松动。结论：成人脊柱退变性侧凸的截骨方式应根据术前影像学资料进行选择,主要因素有局部角状侧后凸畸形、腰椎后凸、椎间隙骨化、僵硬及矢状面失衡情况；尽量使用SPO解决脊柱退变性侧凸的矫形问题,但严重脊柱畸形需要使用PSO进行矫形；两种截骨方式都取得良好的临床和影像学疗效。
[Abstract]:Objective: to investigate the imaging features and osteotomy of adult degenerative scoliosis. Methods: from January 2011 to September 2014, 45 cases of degenerative scoliosis with degenerative scoliosis treated in our hospital were collected. According to the osteotomy pattern, the patients were divided into two groups: 8 males and 20 females. There were 17 cases of cardiovascular disease, 5 cases of respiratory diseases, 11 cases of diabetes mellitus, 17 cases of PSO group, 6 males and 11 females, with an average age of 62.5 years, 6 cases of cardiovascular diseases and 3 cases of respiratory diseases. There were 7 cases of diabetes mellitus. According to preoperative X-ray radiography and CT 3D reconstruction to judge the origin of spinal stiffness and stiffness, SPO or PSO were selected to analyze the imaging indexes and curative effect of the two groups before and after the last follow-up. Results all the 45 cases were successfully operated without death. The follow-up period was 6 to 45 months with an average of 22.4 months. The ODI and VAS scores of the two groups before and at the last follow-up were statistically significant. The improvement rate of the Cobb angle in the P0.05 and SPO group was 69.33. The improvement rate of the Cobb angle in the PSO group was 76.14. The sagittal balance of the spine coronal was re-obtained in both groups. The operative time was 155-290 mins (mean 213min), bleeding volume was 700-1550ml (mean 1253ml), cerebrospinal fluid leakage (5 cases), infection (1 case) and loosening of internal fixation (1 case). The operative time was 160-320min (average 264min, 900-2200ml, average 1756ml), cerebrospinal fluid leakage (4 cases), infection (1 case) and loosening of internal fixation (1 case). Conclusion: the osteotomy of degenerative scoliosis in adults should be selected according to the preoperative imaging data. The main factors are local keratosis, lumbar kyphosis, ossification of intervertebral space, stiffness and sagittal imbalance. SPO was used to solve the problem of degenerative scoliosis, but PSO was needed for correction of severe degenerative scoliosis. Both osteotomy methods achieved good clinical and imaging results.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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