两阶段脊柱切除术治疗体重较低患者的重度僵硬脊柱侧凸

Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China

Background context: To date, there are no clinical series documenting the treatment of severeand rigid scoliosis in patients with low body weight. To optimize curve correction and minimize the risk of complications, we performed a two-stage vertebral column resection (VCR) with posterior pedicle screw instrumentation to treat patients with severe and rigid scoliosis and lowbody weight. Purpose: The purposes of this study were to report the results of a two-staged VCR for patients with severe and rigid scoliosis and low body weight. Study design: This was a prospective, longitudinal, and descriptive study with a minimum follow-up of 2 years. Patientsample: Sixteen patients (nine women and seven men) with severe and rigid scoliosis and lowbody weight from the department of orthopedics, West China hospital, Sichuan University. Outcome measures: Clinical analysis included rib hump and lumbar hump. Radiographic analysis consisted of Cobb angle measurements of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis. All measurements were taken before surgery, after surgery, and in the final follow-up period. Methods: For evaluation of surgical effectiveness, comparative analysis of rib hump, lumbar hump, Cobb angle of coronal curves, apicalvertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis before operation, after operation, and at the most recent follow-up was done. Results: The bodyweight of patients averaged 33.8 kg (range 27-40 kg). Mean operating time was 580.3 minutes, with a blood loss of 1,581.3 mL. The correction rates of rib hump and lumbar hump were 77% and 85%. Preoperative major curves ranged from 90°to 130°Cobb angle. Coronal plane correction of the major curve averaged 70.7%, with an average loss of correction of 1.8%. The apical vertebraltranslation of the major curve was corrected by 73.2%. The preoperative coronal imbalance of 0.6 cm (range 0-1.4 cm) was improved to 0.5 cm (range 0-1.4 cm) at the most recent follow-up. The preoperative sagittal imbalance of 0.9 cm (range -3.1 to 4.6 cm) was improved to 0.8 cm (range -1.0 to 3.0 cm) at the most recent follow-up. The preoperative thoracic kyphosis of 50.1°(range 6°-86°) was corrected to 28.9°±7.7°(range 18°-42°) at the most recent follow-up. The preoperative lumbar lordosis of -57.9°(range -85°to -32°) was corrected to -49.0°(range -62°to -40°) at the most recent follow-up. Complications were encountered in two patients. One patient required ventilator support for 12 hours after anterior surgery. Malposition of one pedicle screw was found in onepatient. There were no neurologic complications or any deep wound infections. No complication of instrumentation was found at final follow-up. Conclusions: The use of two-stage VCR for patientswith severe and rigid scoliosis and low body weight can achieve a good correction of scoliosiswithout serious complications.