后前路联合环形松解保留椎体后壁治疗创伤后僵硬性胸腰椎后凸畸形  

MANAGEMENT OF RIGID POST-TRAUMATIC THORACOLUMBAR KYPHOSIS BY SIMULTANEOUS POSTERIO-ANTERIOR CIRCUMFERENTIAL RELEASING AND CORRECTION WITH PRESERVED POSTERIOR VERTEBRAL WALL

作　　者：王清[1] 王高举[1] 钟德君[1] 修鹏[1] 李森[1] 王松[1] 

机构地区：[1]泸州医学院附属医院脊柱外科,四川泸州646000

出　　处：《中国修复重建外科杂志》2012年第3期261-265,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨后前路联合环形松解、保留椎体后壁的短节段固定融合治疗创伤后僵硬性胸腰椎后凸畸形(rigid post-traumatic thoracolumbar kyphosis,RPTK)的疗效。方法 2004年10月-2010年10月收治RPTK患者20例,采用后前路联合环形松解、保留椎体后壁的椎体次全切除、矫形植骨短节段内固定治疗。男14例,女6例;年龄23～63岁,平均43.2岁。外伤至手术时间4个月～23年,平均1.4年。病变节段:T111例,T128例,L110例,L21例。测量手术前后Cobb角、骨折椎体椎间高度,采用日本骨科协会(JOA)评分评价腰背疼痛。结果术后无切口感染、神经损伤和脑脊液漏等并发症发生。17例获随访,随访时间1～5年,平均2.8年。1例患者术后3个月后凸加重,经延长制动时间获得稳定。末次随访时JOA腰背痛评分为(26.2±3.9)分,较术前(14.0±5.7)分显著改善(t=4.536,P=0.001)。胸腰段后凸Cobb角为(9.8±5.7)°,与术前(43.2±11.5)°比较,差异有统计学意义(P<0.01);骨折椎体椎间高度较术前显著改善(P<0.05),骨折椎体椎间高度恢复至骨折相邻椎体椎间高度的87.0%±11.2%。结论后前路联合环形松解、保留椎体后壁的短节段固定融合技术治疗RPTK,对脊髓干扰小,术中出血少,有助于增强脊柱稳定性和恢复椎间高度。Objective To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis（RPTK） by simultaneous posterio-anterior circumferential releasing,correction and anterior corpectomy with preserved posterior vertebral wall.Methods Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing,anterior subtotal corpectomy with preserved posterior vertebral wall,correction,strut graft,and short segmental fixation.There were 14 males and 6 females with an average age of 43.2 years（range,23-63 years）.The time between injury and operation was 4 months to 23 years（mean,1.4 years）.The affected locations were T11 in 1 case,T12 in 8 cases,L1 in 10 cases,and L2 in 1 case.The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations.The degrees of low back pain were assessed by Japanese Orthopaedic Association（JOA） scores.Results No incision infection,nerve injury,or cerebral spinal fluid leakage occurred.Seventeen patients were followed up 1-5 years with an average of 2.8 years.The JOA score at last follow-up（26.2 ± 3.9） was significantly improved when compared with the pre-operative score（14.0 ± 5.7）（t=4.536,P=0.001）.One patient had aggravation of kyphosis at 3 months postoperatively,who was in stabilized condition after prolonging immobilizated time.The Cobb angle was corrected from（43.2 ± 11.5）° preoperatively to（9.8 ± 5.7）° at last follow-up,showing significant difference（P 0.01）.There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up（P 0.05）.The intervertebral height of fractured vertebra was restored to 87.0% ± 11.2% of adjacent disc height.Conclusion Posterio-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satifactory clinical results,not only in pain relieving,kyphosis correction,vertebral height restoration,and spinal stabil

关 键 词：创伤后僵硬性胸腰椎后凸畸形 环形松解 保留椎体后壁 

分 类 号：R687.3[医药卫生—骨科学]