摘要
目的对改良经椎弓根截骨治疗陈旧性胸腰段脊柱骨折后凸畸形的临床治疗效果进行评价。方法2000年6月至2003年6月共收治26例胸腰段陈旧性骨折后凸局部畸形患者，其中男性16例，女性10例；年龄21～42岁，平均30．6岁。均采用单纯后路经椎弓根＋椎间盘截骨路径，切除后凸顶点（包括伤椎后上角和伤椎上方椎间盘），截骨矫正手术前、后进行系统影像学检查，测量胸腰段Cobb角的变化；手术中记录手术时间，出血量等指标；全部患者术前及手术后3年进行神经功能Frankel评分、腰痛VAS评分和Oswestry腰背、下肢功能评分，并进行对比分析。结果所有患者均获随访，随访时间3～5年，平均d．1年。手术固定范围包括伤椎上、下方各2个节段，平均手术时间（186．0±22．8）min，平均出血量（680．0±31．5）ml。术后胸腰段后凸畸形均明显改善，T10-L2 Cobb角由手术前22．3°±3．5°矫正为2．2°±2．1°，矫正率90．1％±4．5％；没有明显神经损害和其他严重并发症；没有发现椎弓根钉松动、断裂。术前存在神经功能损害的20例患者（Frankel评分D级12例、C级6例、B级2例），术后3年Frankel评分得到改善（E级14例、D级4例、C级1例、B级1例），腰背疼痛VAS评分由术前8．6±1．3改善至2．2±0．5，Oswestry评分由术前（62．5±8．6）％改善至（16．2±4．3）％。结论经椎弓根＋椎间盘截骨治疗陈旧性胸腰段脊柱骨折后凸畸形安全、可靠，具有良好的治疗效果。
Objective To evaluate the outcome of posterior trans-pedicle ＋ disc osteotomy in patients with post-traumatic thoracolumbar kyphosis. Methods Between June 2000 and June 2003, 26 adult patients, 16 male and 10 female, average 30. 6 years old （ 21-42y）, of post-traumatic thoracolumbar kyphosis were corrected by means of single posterior trans-pedicle ＋ disc osteotomy technique. Operation time, blood loss, and surgical complication were counted. Back pain Visual Analog Scale （VAS） Oswestry score and Frankel neurological grade were used to for clinical evaluation. All the radiographic and clinical data were requested at 3 time points （ before operation, directly postoperatively, and at final follow-up）. Results No severe complications were found in this group. Local kyphosis （T10-L2 Cobb angle ） was corrected from average 22. 3° ±3.5° to 2. 2° ±2. 1° （corrective rate 90. 1% ）. Intraoperative average blood loss was （ 680. 0 ± 31.5 ） ml and average operational time was （ 186. 0 ± 22. 8 ） rain. All the patients finished at least 3-5 years follow-up, Neural improvement achieved in this group （ before operation Frankel D 12 cases, Frankel C 6 cases and Frankel B2 cases; 3 years postoperation Frankel E 14 cases, Frankel D 2 cases Frankel C1 case and Frankel B 1 case）, postoperative back pain was reduced from preoperative 8.6 ± 1.3 to 2.2±0.5 in VAS and Oswestry score improved from （62.5 ±8.6）% to （16.2 ±4.3）% at last follow up. Conclusion Single posterior trans-pedicle ＋ disc osteotomy technique is suitable to thoracolumbar post-traumatic kyphosis.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第18期1383-1386,共4页
Chinese Journal of Surgery
关键词
胸腰椎骨折
脊柱截骨
脊柱后凸
Thoraeolumbar vertebra fracture
Osteotomy
Kyphosis
