• 川北医学院附属医院骨科(四川南充,637000);
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【摘要】 目的  探讨经后路全脊截骨联合椎弓根螺钉治疗胸腰椎脊柱后凸畸形的手术评估和临床疗效。 方法  2004年4月-2010年6月采用后路脊椎截骨椎弓根螺钉内固定治疗脊柱后凸畸形15例,其中男11例,女4例;年龄16~61岁,平均49岁。陈旧性胸腰椎骨折后凸10例,结核后凸3例,椎体发育不良2例;后凸顶点:胸9椎体1例,胸11椎体3例,胸12椎体4例,腰1椎体5例,腰2椎体2例。脊柱后凸Cobb角35~61°,平均46°。Frankel分级:E级2例,D级8例,C级4例,B级1例。 结果  术中出血800~1 800 mL,平均1 000 mL;术中1例左侧胸神经根损伤;1例术后双下肢肌力感觉减退。15例患者均获随访,随访时间10~30个月,平均12个月。术后6个月Cobb角5~10°,平均矫正率86.5%。术后6~10个月X线片显示截骨平面骨性愈合,术后神经功能恢复情况,除1例B级恢复至D级外,其余为E级。内固定物无松动、断裂和纠正度数丢失等并发症。 结论  经后路脊柱截骨联合椎弓根螺钉内固定具有减压、矫形同时进行,矫正度数大,并发症少,临床效果明显。
【Abstract】 Objective  To explore the surgery assessment and clinical outcome of the treatment for thoracolumbar kyphosis by whole posterior spinal osteotomy combined with pedicle screw. Methods  Fifteen patients including 11 males and 4 females with kyphosis were treated by posterior spinal osteotomy combined with pedicle screw from April 2004 to June 2010. The age of them ranged from 16 to 61 years old averaging at 49. There were 10 cases of old thoracolumbar fracture kyphosis, 3 cases of tuberculosis kyphosis, and 2 cases of poor vertebral growth. As for kyphosis vertices, there were 1 case of T9, 3 cases of T11, 4 cases of T12, 5 cases of L1, and 2 cases of L2. Kyphosis Cobb angle ranged from 35° to 61°, averaging at 46°. Based on Franke Grade, there were 2 grade E cases, 8 grade D cases, 4 grade C cases, and 1 grade B case. Results  Intraoperative blood loss was from 800 to 1 800 mL with an average of 1 000 mL; There was 1 case of left thoracic nerve root injury during operation and 1 case of lower extremity muscle strength hypoesthesia after operation. All the 15 patients were followed up for 10 to 30 months with an average time of 12 months. Six months after surgery, Cobb angle ranged from 5° to 10°, with an average correction rate of 86.5%. Six to ten months after osteotomy, X ray showed a good bone healing condition. As for the recovery status of neurological function after surgery, All patients recovered to grade E except 1 patient who returned to grade D from grade B. No such complications as fixation without loosening, fracture or loss of correction degree occurred. Conclusion  In posterior spinal osteotomy combined with pedicle screw fixation, decompression and correction can be carried out at the same time to correct a large degree of kyphosis with few complications. The clinical effect is obvious.

引用本文: 蒋成,蒋萍,蔚芃. 后路全脊椎截骨联合椎弓根螺钉治疗胸腰椎脊柱后凸畸形. 华西医学, 2011, 26(7): 1035-1037. doi: 复制