Objective: To investigate the clinical outcome of the coronal Y-shaped osteotomy in the apical vertebra for treating congenital complex rigid scoliosis. Methods: A retrospective analysis was conducted on 66 cases who underwent Y-shaped osteotomy treatment for congenital complex rigid scoliosis in the uppermost vertebra at the Department of Orthopedics,the Second Hospital of Shanxi Medical University from June 2007 to August 2020. There were 19 males and 47 females,with an age of (13.1±5.3) years(range:2 to 30 years).Classification of congenital scoliosis:25 cases (37.9%) were incomplete,13 cases (19.7%) were dysarthritic,and 28 cases (42.4%) were mixed. There were 25 cases (37.9%) with thoracic or rib malformations. 45 cases (68.2%) were complicated with spinal cord malformation.The main radiological indicators included Cobb angle of the curvature,Cobb angle of the local bend,apical vertebral translation (AVT),trunk shift (TS),thoracic trunk shift (TTS),radiographic shoulder height (RSH),coronal balance and sagittal vertebral axis. The preoperative,postoperative immediate,and last follow-up radiological indicators were collected and the operation time,blood loss,hospitalization time,and operation-related complications were recorded. Data were compared by repeated measure ANOVA and paired-t test. Results: All patients underwent surgery successfully. The duration of the first surgery was (221.4±52.8) minutes,and the blood loss during the first surgery was (273.2±41.8) ml. The length of the first hospital stay was (8.8±1.7) days.Unilateral fixation was performed in 19 cases (28.8%),while bilateral fixation was performed in 47 cases (71.2%). The fused segments were 7.5±2.9,and the vertebral pedicle screw density was (68.5±20.6)%. The follow-up time for the 66 patients was (36.7±17.0) months(range:24 to 102 months).The main curve Cobb Angle was improved from (58.5±18.9)°before surgery to (21.1±11.8)°after surgery,and was (23.6±15.3) ° at the last follow-up(F=273.957,P<0.01),with a correction rate of 66.2%. Segmental curve Cobb Angle was improved from (47.9±18.0)° to (16.0±11.3)° after surgery,and was (16.8±12.8) °at the last follow-up (F=270.483,P<0.01)with a correction rate of 69.2%. The AVT,TS,TTS and RSH values improved significantly at the final follow-up (all P<0.05),while coronal balance and sagittal vertical axis were maintained without significant differences between pre-operation and post-operation(both P>0.05). A total of 5 patients underwent staged operation,all of which were residual scoliosis aggravated after the first stage of orthosis operation and had good prognosis after the second stage of operation. Conclusions: Y-shaped osteotomy for the treatment of congenital rigid scoliosis results in good clinical and radiological outcomes without serious complications. This procedure can be considered as an option for the treatment of congenital complex rigid scoliosis.
目的： 探讨冠状位顶椎区“Y”形截骨治疗先天性复杂僵硬性脊柱侧凸的临床效果。 方法： 回顾性分析2007年6月到2020年8月于山西医科大学第二医院骨科采用顶椎区“Y”形截骨治疗的66例先天性复杂僵硬性脊柱侧凸患者的临床资料。男性19例，女性47例，年龄（13.1±5.3）岁（范围：2~30 岁）。先天性脊柱侧凸分型：分节不全（25例）、形成障碍（13例）、混合型（28例）；合并胸廓或肋骨畸形25例；合并脊髓畸形45例。记录并比较患者术前、术后即刻和末次随访时的主弯Cobb角、节段Cobb角、顶椎偏距、躯干偏移、胸廓躯干偏移、肩部平衡和冠状位、矢状位平衡。记录手术时间、出血量、住院时间及手术相关并发症等。数据比较采用重复测量方差分析和配对样本t检验。 结果： 66例患者均顺利完成手术，初次手术时间（221.4±52.8）min，手术出血量（273.2±41.8）ml，单侧固定19例（28.8%）、双侧固定47例（71.2%）；融合节段为（7.5±2.9）个，椎弓根钉密度为（68.5±20.6），住院时间（8.8±1.7）d。患者随访时间（36.7±17.0）个月（范围：24~102个月）。主弯Cobb角由术前的（58.5±18.9）°改善至术后即刻的（21.1±11.8）°，末次随访时为（23.6±15.3）°（F=273.957，P<0.01），平均矫正率为66.2%；节段弯Cobb 角由术前的（47.9±18.0）°，改善至术后即刻的（16.0±11.3）°，末次随访时为（16.8±12.8）°（F=270.483，P<0.01），平均矫正率为69.2%。末次随访时的顶椎偏距、躯干偏移、胸廓躯干偏移、肩部平衡与术前相比均明显改善（P值均<0.05）；手术前后冠状位及矢状位平衡无差异（P值均>0.05）。共5例患者实施了分期手术，均为一期矫形后残留侧弯加重，经二期手术后恢复良好。 结论： 顶椎区“Y”形截骨技术治疗先天性僵硬性脊柱侧凸可以取得良好的临床和影像学结果，且无严重并发症发生，可作为治疗先天性复杂僵硬性脊柱侧凸的一种选择。.