全脊椎截骨梯次矫形治疗重度脊柱角状后凸畸形

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Abstract Objective To evaluate the safety and clinical outcomes of posterior vertebral column resection (PVCR) combined with stepwise correction technique in the treatment of patients with severe angular kyphosis.Methods A prospective study was designed on patients.From January 2015 to December 2016，37 patients with severe angular kyphosis underwent PVCR combined with stepwise correction technique，including16 males and 21 females with an average age of 28.6 years old (range 11～58 years).Relevant radiographic parameters were recorded pre-operatively，post-operatively and at last follow-up，included Cobb angle，global kyphosis(GK)，Trunk shift(TS) and sagittal vertical axis(SVA). The clinical outcomes were evaluated by MOS item short-form health survey(SF-36)，visual analogue scale(VAS) and Oswestry disability index(ODI)，while neurological function was evaluated by Frankel classification.Perioperative complications were analyzed as well.Results The average operation time was (468.9±108.3)min (range 312～723 min)with an average blood loss of (2 173.7±1 226.6)mL (range 800～5 100 mL).The average follow-up time was 22.5 months (12~40 months).The pre-operative average GK angle and Cobb angle were (124±20.4)°(range 91°~160°)and (87.2±45.2)°(range 0°~156°).The post-operative average GK angle and Cobb angle were (46.8±21.5)°(range 10°～120°)and (49.1±26.9)°(range 0°～109°).The correction rate of GK angle and Cobb angle were 62.3% and 45.2%，respectively.At last follow-up，no significant loss of correction was observed in the GK angle and Cobb’s angle.The pre-operative and post-operative TS were (38.6±17.2)mm，(11.5±11.2)mm，respectively，SVA decreased from pre-operative (33.5±11.4)mm to (9.6±7.2)mm post-operatively，significant improvement of TS and SVA were observed.In addition，compared with SF-36，VAS，ODI values in pre-operation，the values in both post-operation and the last follow-up have significant improvement.The incidence of perioperative complications was 37.8% (n＝14)including complete paralysis (n＝1)，transient neurological deficit (n＝3)，hemothorax (n＝2)，poor wound healing (n＝3)，the digestive system complications (n＝3)，screw pull-out (n＝1)and screw cap dislodgement(n＝1).Conclusion Posterior vertebral column resection combined with stepwise correction technique can achieve satisfactory correction for severe angular kyphosis.However，more blood loss，longer operative time needed in these procedures，and high incidence of perioperative complications must be attentioned.

Key words： angular kyphosis kyphoscoliosis posterior vertebral column resection complications

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