后路经椎弓根截骨术治疗陈旧性胸腰椎骨折伴后凸畸形  

Treatment of chronic posttraumatic thoracolumbar kyphosis by posterior pedicle subtraction osteotomy

作　　者：西永明[1] 陈伯华[1] 齐宗华[1] 刘向军[2] 张成风[2] 刘勇[1] 马进峰[1] 张国庆[1] 邹云雯[1] 陈晓亮[1] 胡有谷[1] 

机构地区：[1]青岛大学医学院附属医院脊柱外科,266003 [2]胶南市人民医院骨科

出　　处：《中华创伤杂志》2010年第9期813-816,共4页Chinese Journal of Trauma

摘　　要：目的 回顾性分析后路经椎弓根截骨术治疗胸腰椎陈旧骨折伴后凸畸形的临床疗效. 方法陈旧性胸腰椎骨折伴后凸畸形19例,其中男11例,女8例;年龄29～61岁,平均42岁.后凸畸形Cobb角31°～63°,平均47°;病史8～63个月,平均29个月.根据后凸角度大小、椎管狭窄程度和压迫来源采用经椎弓根椎体闭合楔形截骨术. 结果患者获得平均40.2°的矫正,平均矫正率85.8%.并发症包括脑脊液漏2例,切口浅表感染1例.无重大手术并发症.随访时间平均15个月（6～41个月）,末次随访时临床症状和神经功能获得明显改善,无明显矫正丢失和内固定物失败并发症,X线片和动态X线片显示骨性融合,融合率100%. 结论对于胸腰椎骨折迟发性后凸畸形,Ⅰ期后路经椎弓根截骨术是理想选择,单节段截骨控制在55°内是安全的.Objective To retrospectively evaluate and analyze the clinical effect of posterior pedicle subtraction osteotomy in treating chronic, posttraumatic thoracolumbar kyphosis. Methods Nineteen patients （11 males and 8 females） with chronic, posttraumatic thoracolumbar kyphosis were corrected surgically. The patients were at age range of 29-61 years （mean 42 years）. Preoperative kyphosis Cobb angle ranged from 31° to 63° （mean 47°） and trauma history ranged from 8 months to 63 months （mean 29 months）. All patients were treated with pedicle subtraction osteotomy according to the size of Cobb angle, extent of spinal stenosis and source of compression. Results Sagittal alignment was improved to average 40.2°, with a correction rate of 85.8%. Two patients developed postoperative leakage of cerebrospinal fluid. Among them, one was combined with encephalic infection and cured with active treatment, and the other developed postoperative wound infection, which were treated conservatively with antibiotics and local wound care. There were no other severe complications. The average follow-up period was 15 months （range 6-41 months）. At the last follow-up, clinical symptoms and neurological function were improved significantly. Neither loss of correction nor failure of internal fixators was observed. X-ray and dynamic X-ray films showed a 100% fusion in all patients. Conclusions The single-stage posterior pedicle subtraction osteotomy is a safe and effective procedure for correction of posttraumatic thoracolumbar kyphosis. It is possible and safe to obtain a correction within 55° on single segment by this technique.

关 键 词：脊柱骨折 胸椎 腰椎 椎弓根 

分 类 号：R686[医药卫生—骨科学]