经椎弓根有限截骨治疗创伤性胸腰段后凸畸形  

Surgical correction of post-traumatic thoracolumbar kyphotic deformity with posterior transpedicular limited osteotomy technique

作　　者：李劲松[1] 陈世杰[1] 王卫国[1] 吴松[1] 张朝跃[1] 臧晓方[1] 

机构地区：[1]中南大学湘雅三医院骨科,长沙410013

出　　处：《中南大学学报（医学版）》2014年第6期632-637,共6页Journal of Central South University ：Medical Science

摘　　要：目的:探讨一期后路经椎弓根有限截骨治疗创伤性胸腰段后凸畸形的临床疗效.方法:收治17例陈旧性创伤性胸腰段后凸畸形患者,均采用经椎弓根有限截骨治疗.术前Cobb角41°～62°(52.5°±6.4°);矢状面平衡用站立侧位片颈7垂线与骶1后上角(C7～S1)水平距离评价,术前神经功能评价采用美国脊髓损伤学会(American Spinal InjuryAssociation,ASIA)评级、Oswestry功能障碍指数(oswestry disability index,ODI)和视觉模拟评分(visual analogue scale,VAS).记录手术时间、出血量和并发症,对比分析术前、术后及随访过程Cobb角、ODI和VAS.结果:患者随访时间24～53(34.5±7.1)个月;手术时间180～400(287.1±65.9) min;出血量350～1 300(838.2±276.4) mL;术后后凸Cobb角3°～12°(6.1°±3.0°),末次随访时为7.5°±2.6°;术后C7～S1水平距离为(3.6±3.9) mm,末次随访时为(3.4±2.3) mm;末次随访时ASIA评级:D级4例,E级13例;ODI为(5.2±2.4)分;VAS为(2.4±1.0)分.2例患者术后出现脑脊液漏,1例出现切口深部感染,3例患者术后出现肋间神经痛症状,经对症治疗后均好转.1例术后12周发生断棒,1例术后4个月椎弓根钉松动脱出,均行二期翻修术,矫形角度无丢失.所有患者经X线片和CT证实截骨部位均在术后1年内骨性融合.结论:一期后路经椎弓根有限截骨是治疗轻中度陈旧性创伤性胸腰段后凸畸形的一种安全有效的手术方式.Objective: To evaluate the clinical outcome of surgical management for post-traumatic thoracolumbar kyphotic deformity with single-stage posterior transpedicularlimited osteotomies. Methods: From March 2007 to May 2010, 17 patients with post-traumatic thoracolumbar kyphotic deformity treated with posterior limited transpedicular osteotomy were admitted. The preoperative Cobb angle was 41°-62°(52.5°±6.4°). Sagittal balance was evaluated by the standing lateral films measuring the C7 plumb line distance(C7 PLD) from the posterior superior corner of S1. The C7 PLD was 18-58(41.2±12.4) mm in the sagittal plane. The preoperative oswestry disability index(ODI) was 42-50(45.7±2.7), and the average preoperative visual analogue scale(VAS) was 8-10(8.8±0.7). The American Spinal Injury Association(ASIA) impairment scale was used to assess the neurological deficits, and grade C in 1 patient, grade D in 7 and grade E in 9 patients. The operation time, blood loss, complications, post-operative Cobb angle, ODI and VAS score at the follow-up were collected and analyzed. Results: The average duration of postoperative follow-up was 24-53(34.5±7.1) months. The operation time was 180-400(287.1±65.9) min, with an blood loss of 350-1 300(838.2±276.4) mL. The postoperative kyphotic angle was 3°-12°(6.1°±3.0°), and it was 7.5°±2.6° at the final follow-up evaluation. The postoperative C7 PLD was(3.6±3.9) mm and it was(3.4±2.3) mm at the final follow-up evaluation. Postoperatively, the ASIA impairment scale was grade D in 4 and grade E in 13 patients. At the final follow-up ODI and VAS were reduced to an average of 5.2±2.4 and 2.4±1.0, respectively. Cerebrospinal fluid leakage was found in 2 patients, deep wound infection in 1, and intercostal neuralgia in 2. All the complications were relieved after conservative medical therapy. One patient received additional surgery at postoperative 12 weeks due to breakage of posterior implants. Another screw pullout case was treated with reinsertion of larger screws at postoper

关 键 词：胸腰段后凸畸形 有限截骨 单独后路 矢状面平衡 

分 类 号：R687.3[医药卫生—骨科学]