陈旧性胸腰椎骨折伴后凸畸形的微创外科治疗  

Minimally invasive surgical treatment of post-traumatic thoracolumbar kyphosis

作　　者：李长青[1] 周跃[1] 王建[1] 初同伟[1] 张正丰[1] 郑文杰[1] 罗刚[1] 

机构地区：[1]第三军医大学附属新桥医院骨科,重庆400037

出　　处：《中华创伤杂志》2010年第12期1109-1112,共4页Chinese Journal of Trauma

摘　　要：目的 探讨陈旧性胸腰椎骨折伴后凸畸形的微创外科治疗安全性及有效性.方法 选择2009年4月-2010年2月收治的陈旧性胸腰椎骨折伴后凸畸形患者7例,其中男4例,女3例;年龄（45.3±6.7）岁,均存在明显腰背痛.全身麻醉下行Quadrant辅助下关节突截骨、椎间盘切除、椎间植骨融合、经皮Sextant系统复位内固定术.采用视觉模拟疼痛评分法（visual analog scale,VAS）、功能障碍指数（Oswestry disability index,ODI）、Cobb角等评定疗效.结果 手术时间平均135 min,平均出血量106 ml,无手术并发症发生.随访4～16月,平均5.5个月,术前VAS评分为（7.6±3.5）分,术后3个月为（2.5±1.3）分（P＜0.01）;术前ODI为53.6±24.2,术后3个月为20.6±6.3（P＜0.01）;术前Cobb角为（32.1±4.5）°,术后3个月为（7.3±2.9）°（P＜0.01）.结论 Quadrant辅助下微创经关节突截骨矫形术是治疗陈旧性胸腰椎骨折伴后凸畸形的安全且有效的微创手术.Objective To determine the safety and efficacy of minimally invasive surgical treatment for post-traumatic thoracolumbar kyphosis. Methods A retrospective review was performed on seven patients with post-traumatic thoracolumbar kyphosis admitted from April 2009 to February 2010.There were four males and three females, at average age of 45.3 years. After general anesthesia, minimally invasive transarticular osteotomy and multi-level SextantTM percutaneous reduction and internal fixation were performed under QuadrantTM working tube system. The status of pain and ability was evaluated by using visual analogue scale （VAS） and Oswestry disability index （ODI）. The kyphotic deformity was evaluated by using the Cobb＇s angle. Results The operation lasted for mean 135 minutes, with mean perioperative blood loss of 106 ml but with no any complications occurred. The mean follow -up period was 5.5 months （ range 4 -16 months ）. The mean VAS score was improved from preoperative （ 7.6 ±3.5） points to postoperative （2.5 ± 1.3） points, with statistical difference （P 〈0.01 ）. The mean ODI was improved from preoperative 53.6 ± 24.2 to postoperative 20.6 ± 6.3, with statistical difference （ P 〈0.01 ）. The Cobb angle was also improved from preoperative （ 32. 1 ± 4.5 ） ° to postoperative （ 7.3 ±2.9 ） °, with statistical difference （ P 〈 0. 01 ）. Conclusion Minimally invasive transarticular osteotomy under QuadrantTM working tube system is a safe and effective alternative for dealing with post-traumatic thoracolumbar kyphosis.

关 键 词：脊柱骨折 胸椎 腰椎 外科手术 微创性 

分 类 号：R686[医药卫生—骨科学]