摘要
目的分析手术治疗胸、腰椎骨折后脊柱后侧凸畸形的效果.方法回顾性分析胸、腰椎骨折晚期脊柱后侧凸畸形患者10例,术前后凸cobb角33°～68°(平均47°),侧凸cobb角30°～52°(平均38°).其中单纯后路截骨矫形植骨内固定2例;6例一期前路截骨松解、后路矫形植骨内固定;2例先行前、后路一期截骨松解,牵引10～14 d后再行后路矫形植骨融合内固定.结果本组病例随访9～36个月(平均23个月),术中、术后无脊髓损伤加重,腰背疼痛症状消失,脊髓损伤神经功能有所恢复,植骨部位均获得骨性愈合.后凸cobb角0°～15°(平均9°),纠正率为79%;侧凸cobb角7°～19°(平均13°),纠正率为71%.结论手术治疗有助于矫正胸、腰椎骨折晚期脊柱后侧凸,重建脊柱矢状位及冠状位的平衡,并有利于神经功能恢复.应根据后侧凸的类型、畸形的柔韧性及躯干的平衡选择适当的融合范围和手术方式.
Objective To analyze the outcome of surgical treatment for kyphoscoliosis secondary to thoracolumbar fracture. Methods A retrospective study was performed in 10 patients with kyphoscoliosis following thoracolumbar fracture. The preoperative cobb angle of kyphosis was ranged from 33°to 68°（mean 47°）,while the cobb angle of scoliosis was from 30°to 52°（mean 38°）. The posterior corrective osteotomy with bone graft and stabilization were performed solely in 2 cases. Anterior release by osteotomy and posterior correction and bone graft with stabilization were simultaneously done in 6. In 2 cases the anterior and posterior release were done primarily with traction for 10～14 days and then followed by posterior correction and bone graft with internal fixation. Results The mean follow-up of 23 （9-36） months revealed bone healing, recovery of the injured spinal cord, decrease of low back pain, but no aggravation of the spinal cord injury. The cobb angle of kyhposis was ranged from 0°to 15°（ mean 9°）with a correction rate of 79 %. The cobb angle of scoliosis was from 7°to 19°（mean 13°） with a correction rate of 71%. Conclusions The operative management can help to correct kyphoscoliosis following thoracolumbar vertebral fracture, to reestablish the sagittal and coronal balance, and to facilitate the neural functional recovery. The appropriate range of fusion level and operative procedures should be based on the curved type, flexibility and trunk balance before operation. （Shanghai Med J, 2005, 28.-558-560）.
出处
《上海医学》
CAS
CSCD
北大核心
2005年第7期558-560,F0006,共4页
Shanghai Medical Journal
