摘要
目的探讨后路Ⅳ级截骨术在椎间盘组织嵌入骨折椎体的陈旧性胸腰椎骨折并后凸畸形手术治疗中的应用价值。方法回顾性分析自2015-01—2017-12诊治的36例椎间盘组织嵌入椎体陈旧性胸腰椎骨折并后凸畸形,行后路Ⅳ级截骨(经椎弓根V形截骨并切除相邻椎间盘)、椎弓根钉内固定、全椎板减压椎间植骨融合术治疗。比较术前、术后1周、术后3个月疼痛VAS评分、伤椎Cobb角、ODI指数。结果 36例均获得随访,随访时间平均9.2(3～18)个月。所有患者腰背部疼痛均明显缓解,未出现脊髓神经功能损伤加重,术后6个月均有明确的椎间骨性融合影像学表现。术后1周疼痛VAS评分、伤椎Cobb角、ODI指数较术前明显改善,差异有统计学意义(P<0.05);术后3个月疼痛VAS评分、ODI指数较术后1周进一步改善,但伤椎Cobb角较术后1周有所丢失,差异有统计学意义(P<0.05)。结论对于椎间盘组织嵌入椎体陈旧性胸腰椎骨折并后凸畸形患者,Ⅳ级截骨术是一种合适的治疗选择,可以取得良好的疗效。
Objective To evaluate the value of posterior Ⅳ grade osteotomy in the treatment of old thoracolumbar fractures and kyphosis with intervertebral disc tissue embedded in fracture vertebral body. Methods Thirty-six cases of old thoracolumbar fractures and kyphosis with intervertebral disc tissue embedded in the vertebral body from January 2015 to December 2017 were retrospectively analyzed. These patients were treated with posterior Ⅳ grade osteotomy (transpedicular V-shaped osteotomy and resection of adjacent intervertebral discs), pedicle screw fixation, and total laminectomy decompression and interbody fusion). The changes in clinical symptoms before and 1 week and 3 months after surgery from VAS scores, Cobb angle, and ODI index were observed. Results All 36 cases were followed up for an average of 9.2 months (3-18 months). All patients had obvious relief of low back pain symptoms, and no patients had increased spinal nerve function damage after operation. Patients were found to have clear intervertebral fusion imaging findings at 6 months after surgery. The VAS score was significantly improved 1 week after surgery, and the same results were obtained for the Cobb angle and ODI index of the injured vertebra, the difference was statistically significant (P <0.05). The VAS score and ODI index were further improved at 3 months after surgery than 1 week after operation, However, the corrected Cobb angle of the injured vertebra at 3 months after surgery was slightly lost compared with 1 week after surgery, the difference was statistically significant (P <0.05). Conclusion The posterior grade IV spinal osteotomy is a suitable treatment option and can achieve good results in kyphosis patients of old thoracolumbar fracture with intervertebral disc tissue embedded in fractured vertebral body.
作者
金志辉
方洪松
陈森
彭昊
郭卫春
JIN Zhi-hui;FANG Hong-song;CHEN Sen;PENG Hao;GUO Wei-chun(Department of Orthopedics,Renmin Hospital of Wuhan University,Wuhan,Hubei 430060,China)
出处
《中国骨与关节损伤杂志》
2019年第3期237-240,共4页
Chinese Journal of Bone and Joint Injury
关键词
陈旧性胸腰椎骨折
后凸畸形
椎间盘组织嵌入骨折椎体
Ⅳ级截骨术
椎弓根钉
植骨融合
Old thoracolumbar fracture
Kyphosis
Intervertebral disc tissue embedded in fractured vertebral body
Posterior Ⅳ grades osteotomy
Pedicle screw
Bone graft fusion
