Objective: To investigate the surgical strategy and mid-and long-term outcomes of neurofibromatosis associated cervical kyphotic deformity. Methods: Thirteen patients with neurofibromatosis associated cervical kyphotic deformity operated in Shanghai Changzheng Hospital from January 1998 to December 2015 were analyzed retrospectively. There were 7 males and 6 females in this group, aged from 12 to 61 years, with an average age of (28±15) years. Eight patients were treated with anterior surgery (Group A) and 5 patients were treated with combined anterior and posterior surgery (Group A+P). Cobb angle correction of cervical kyphosis and improvement of clinical symptoms were followed up. Clinical efficacy between the two groups was compared and analyzed. Chi-square test, Fisher exact test and independent sample t test were used for comparative analysis between the two groups. Results: All patients were operated successfully and finished follow up. The follow-up period was from 42 to 128 months ((80±22) months). After the surgery, neurological symptoms and pain were significantly improved in all patients. Compared with preoperative values, Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score for pain at the last follow-up were significantly improved (t=7.63, -5.19, 8.63, -4.75, all P<0.01). Cervical kyphosis was significantly improved in all patients after surgery. In group A, the Cobb angle was improved from 64°±24° preoperatively to 12°±11° at the last follow-up, and the average correction rate of Cobb angle was 82.6%. In group A+P, the Cobb angle was improved from 55°±10° preoperatively to 7°±9° at the last follow-up, and the average correction rate of Cobb angle was 88.3%. The operation time, intraoperative blood loss and length of stay in group A were all significantly lower than those in group A+P (t=-6.32, -11.92, -6.52, all P<0.01). At the last follow-up, there was no significant difference in Cobb angle, JOA score and VAS score between the two groups (t=0.89, 0.94, 1.02, all P>0.05). Conclusions: Mid-and long-term results of anterior and combined anterior and posterior surgery for neurofibromatosis associated severe cervical kyphosis are satisfactory. Moderate correction strategy for cervical kyphosis is safe and effective. The incidence of complications of nerve injury can be reduced.
目的： 探讨神经纤维瘤病伴重度颈椎后凸畸形的手术策略和中长期疗效。 方法： 对1998年1月至2015年12月于上海长征医院手术治疗的13例神经纤维瘤病性颈椎后凸畸形患者的中长期随访资料进行回顾。其中男7例，女6例，年龄12~61岁，平均（28±15）岁。单纯前路手术（A组）共8例，前后路联合手术（A+P组）共5例。对颈椎后凸Cobb角度的矫形程度、临床症状改善情况进行随访，并对两组临床疗效的差异进行比较分析。两组间比较分析采用χ(2)、Fisher精确检验及独立样本t检验。 结果： 本组13例患者均顺利完成手术并获得随访，随访时间42~128个月，平均（80±22）个月。术后所有患者神经症状及颈肩部疼痛程度均较术前明显改善。末次随访时日本骨科学会（JOA）评分、疼痛视觉模拟（VAS）评分与术前比较差异均有统计学意义（t=7.63、-5.19、8.63、-4.75，均P<0.01）。术后所有患者颈椎后凸畸形明显改善。A组后凸Cobb角由术前64°±24°改善至末次随访的12°±11°，颈椎Cobb角矫正率为82.6%；A+P组后凸Cobb角由术前的55°±10°改善至末次随访的7°±9°，颈椎Cobb角矫正率为88.3%。A组手术时间、术中出血量、住院时间均显著少于A+P组差异均有统计学意义（t=-6.32、-11.92、-6.52，均P<0.01）。末次随访时，两组颈椎后凸Cobb角、JOA评分、VAS评分差异均无统计学意义（t=0.89、0.94、1.02，均P>0.05）。 结论： 前路手术和前后联合手术治疗神经纤维瘤病伴重度颈椎后凸畸形中长期随访疗效满意。颈椎后凸的适度矫形能够满足手术效果，同时提高了手术安全性，减少了神经损伤并发症。.
Keywords: Cervical kyphosis; Clinical efficacy; Neurofibromatosis; Surgical treatment.