脊柱后凸是一类发病机理十分复杂的疾病,该疾病是由于随着年龄的增长肌肉萎缩以及肌肉附着点相应韧带的松弛肌纤维的张力不够、骨质变得软化,长时间的久坐久站,在地球重力的不断作用下所导致的骨骼畸形。随着疾病的发生和发展,畸形会逐步加剧并导致腰背部疼痛的发生,甚至发生瘫痪,合并有神经功能障碍,保守治疗效果欠佳。随着临床技术的迅猛发展以及人民生活水平的大幅度提高,多采用矫形手术对此进行干预和治疗,以此来改善患者的病情,缓解疼痛,恢复正常的人体脊柱解剖学形态,减轻神经受压迫症状。本文就脊柱后凸畸形的病因及临床表现,后入路经椎弓根椎体截骨术(PSO)的基本方法、适应症及优缺点进行综述。Kyphosis is a kind of disease with very complex pathogenesis. It is caused by muscle atrophy with age, insufficient tension of muscle fibers corresponding to the muscle attachment point, softening of bone, sitting and standing for a long time, and bone deformities under the constant action of the gravity of the earth. With the occurrence and development of the disease, the deformity will gradually aggravate and lead to the occurrence of back pain, even paralysis, combined with neurological dysfunction, and the effect of conservative treatment is not good. With the rapid development of clinical technology and the substantial improvement of people’s living standards, orthopedic surgery is often used for intervention and treatment to improve the patient’s condition, relieve pain, restore the normal anatomy of the human spine, and relieve the symptoms of nerve compression. This article reviews the etiology and clinical manifestations of kyphosis, and the basic methods, indications, advantages and disadvantages of pedicle subtraction osteotomy (PSO).
目的评估在个性化3D打印导板引导下,行经椎体内截骨术、脊柱内固定术治疗重度脊柱后凸手术的矫形率、椎弓根钉位准确性和治疗效果。方法本研究为单中心非随机性临床试验研究,样本涵盖2018年12月至2023年6月期间接受经椎体内截骨术的19例患者(男性8例,女性11例)。其中7例患者为导板组,采用计算机辅助设计(CAD)技术进行术前手术规划和术中个性化3D打印导板引导,12例患者为传统组,采用传统置钉矫正。术后评估包括后凸Cobb角、脊柱矫正率、钉位准确性和Oswestry功能障碍指数问卷调查(Oswestry Dysfunction Index,ODI)。结果研究纳入患者19例,平均年龄48.0岁。平均随访26.4(9~54个月)。所有患者均获得相对满意的矫正效果,导板组平均矫正率为96.83%,传统组为86.61%。导板组与传统组平均术中出血量(857 vs 1045 mL)和平均手术时间(344 vs 402 min)差异无统计学意义,平均住院时间(11 vs 18 d)差异具有统计学意义(P<0.05)。本研究共置钉278枚,其中导板辅助置钉70枚,97.1%为A级或B级;传统组置钉208枚,其中93.8%为A级或B级。术后CT/X线检查显示导板组与传统组后凸畸形矫正均达到一定程度矫正,2组的平均矫正角度(43.37°vs 36.10°)差异无统计学意义;而导板组的矫正率显著高于传统组(96.83%vs 86.61%,P<0.01);ODI评分导板组显著低于传统组(P<0.05)。结论在脊柱截骨术中,利用计算机辅助技术进行术前规划、手术模拟和个性化3D打印导板的辅助,能够改善术后矫形率,提高置钉的准确性,改善严重脊柱后凸畸形患者的生活质量。