一期后路全脊椎切除并内固定矫形治疗胸腰椎疾患  

One-stage Posterior Total Spondylectomy and Internal Fixation for Lesions of Thoracic and Lumber Vertebra

作　　者：姚晓东[1] 唐焕章[1] 李金泉[1] 陈建梅[1] 王万宗[1] 徐皓[1] 

机构地区：[1]南京军区福州总医院骨科,福建省福州市350025

出　　处：《中国骨与关节损伤杂志》2011年第1期11-13,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察一期后路全脊椎切除并内固定矫形治疗胸腰椎疾患的疗效。方法对17例胸腰椎疾患（6例陈旧性脊柱骨折脱位,4例全脊椎结核,5例脊柱侧后凸畸形,2例全脊椎肿瘤）全脊柱切除的疗效进行回顾性分析。其中14例伴有后凸或侧后凸成角畸形,12例病变节段以下完全或不完全性瘫痪。对所有患者一期经后路行病椎全脊椎切除,环脊髓减压、椎间撬拔撑开复位,可调式中空笼状钛合金人工椎体或钛网复合自体骨碎骨粒置入,辅以后路椎弓根钉棒系统行邻近椎节固定,一期重建脊柱稳定性,观察术后局部疼痛缓解、脊髓神经功能恢复、脊柱椎节的稳定性及后凸或侧后凸畸形的矫形治疗情况。结果随访12～26个月,平均18个月,患者术后疼痛缓解,肿瘤、结核病人术后局部均无复发,脊髓神经功能无加重损伤,11例脊髓神经功能得到不同程度恢复。术后影像学检查提示：脊柱内固定物在位,椎体序列恢复良好,椎间高度恢复。结论一期后路全脊椎切除并内固定术具有创伤小、减压彻底、能有效重建脊柱稳定,恢复脊柱序列等优点。Objective To observe the clinical results of one-stage posterior total spondylectomy and internal fixation for the lesions of thoracic and lumber vertebra.Methods Six cases of severe fracture of the thoracic and lumber spine,4 cases of tuberculosis,5 cases of kyphosis and scoliosis,and 2 cases of tumor,of which 14 cases with kyphosis and scoliosis,and of which 12 cases with paralysis,were treated by one-stage procedure,including posterior total spondylectomy,circumspinal cord decompression,bone grafting,implant adjustable hollow titanium artificial vertebral body or titanium cage and transpedicular internal fixation through a single posterior approach and reconstruction of spinal stability.Relief of the pain,the function of spinal cord or nerve,kyphosis and scoliosis collection and spinal stability were monitored.Results Postoperatively,the period of follow-up lasted for 12 months to 26 months with a mean of 18 months.All these patients had their incision healed by first intention,and no recurrence was noted in those patients with tumor and tuberculosis.All patients experienced significant palliation local pain,and 11 patients showed improved neurological status（at least one grade improvement on Frankel’s functional classification）.The instrumentation provided immediate stability and protected against development of kyphosis and scoliosis in all patients.Postoperative radiological evaluation revealed that implants were stable,there were no phenomena of prosthesis subsidence,and failure restoration of spinal segments height.Solid bony fusion was obtained in all patients.Conclusion The single-stage posterior total spondylectomy and internal fixation for the lesions of thoracic and lumber vertebra is a ideal treatment with less trauma,thorough decompression,reconstruction of spinal stability and resume spinal sequence.

关 键 词：全脊椎切除 胸腰椎 重建 外科治疗 

分 类 号：R738.1[医药卫生—肿瘤]