环钻经椎弓根截骨治疗伴后凸畸形的陈旧性胸腰椎压缩骨折  

Pedicle subtraction osteotomy with trephine for old thoracolumbar compression fracture withkyphotic deformity

作　　者：丁文元[1] 申勇[1] 张英泽[1] 王辉[1] 张为[1] 杨大龙[1] 马雷[1] 孙亚澎[1] 谢东晓[1] 马铮[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中华骨科杂志》2012年第10期973-978,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨环钻在经椎弓根截骨（pedicle subtraction osteotomy，PSO）治疗陈旧性胸腰椎压缩骨折伴后凸畸形中的价值。方法回顾性分析2005年2月至2010年2月行常规PS0和应用环钻行PSO治疗37例陈旧性胸腰椎压缩骨折伴后凸畸形患者资料。常规组21例，男14例，女7例；年龄（55．6＋3．7）岁；后凸角为45．3°±4．6°。环钻组16例，男11例，女5例；年龄（53．3±4．2）岁；后凸角为47．6°±5．9°。评估患者的疼痛改善情况及神经功能改善率。结果患者均获得随访，常规组随访时间为12-22个月，环钻组为13-20个月。手术时间、出血量、人均输血量常规组分别为平均（224±45）min、（1043±234）ml、（876±300）ml，环钻组分别为平均（180±31）min、（785±163）ml、（500±230）ml。Cobb角术后平均矫正率及末次随访时Cobb角矫正丢失率常规组分别为91．4％、5．8％，环钻组分别为90．9％、6．2％。JOA评分改善率常规组为81．1％，环钻组为83．7％；常规组VAS评分降低（7．7±1．1）分，环钻组降低（7．8±0．8）分。术后常规组1例患者诉鞍区麻木，末次随访时基本正常。两组术后均无感染、血栓形成，末次随访时截骨间隙及后方植骨已融合，无假关节形成，无螺钉松动、断裂、脱出等并发症。结论环钻用于PSO治疗陈旧性胸腰椎压缩骨折伴后凸畸形可明显缩短手术时间，减少术中出血，提高截骨效率。Objective To explore value of trephine in pedicle subtraction osteotomy （PSO） for old thoracolumbar compression fracture with kyphotic deformity. Methods Thirty seven patients who underwent surgical treatment for old thoracolumbar kyphotic deformity in our hospital from February 2005 to February 2010 were retrospectively reviewed. Among them, 21 patients underwent conventional PSO and 16 patients underwent PSO with trephine. In conventional PSO group, there were 14 males and 7 females, the average age was 55.6±3.7 years and the mean Cobb angle was 45.3°±4.6°. In PSO with trephine group, there were 11 males and 5 females, the average age was 53.3±4.2 years and the mean Cobb angle was 47.6°±5.9°. Results All patients were successfully followed up. The duration of follow-up ranged from 12 to 22 months in conventional PSO group, while 13 to 20 months in PSO with trephine group. The operation time, blood loss, amount of blood transfusion were 224±45 rain, 1043＋234 ml, 876±300 ml respectively in conventional PSO group, while 180± 31 min, 785±163 ml, 500±230 ml in PSO with trephine group. Immediately after operation, correction rate of Cobb angle was 91.4% in conventional PSO group and 90.9% in PSO with trephine group. At final follow-up, the correction of Cobb angle lost 5.8% in conventional PSO group and 6.2% in PSO with trephine group. The improvement rate of JOA score was 81.1% in conventional PSO group and 83.7% in PSO with trephine group. The VAS score decreased 7.7±1.1 in conventional PSO group and 7.8±0.8 in PSO with trephine group. One patient in conventional PSO group experienced saddle numbness immediately after operation, which alleviated at final follow up. All patients achieved bony fusion at final follow up. No infection, screw loosening or breakage occurred in both groups. Conclusion The use of trephine in PSO for old thoracolumbar compression fracture with kvohotic deformity can reduce operation time, blood loss and improve efficiency of osteotomy.

关 键 词：胸椎 腰椎 截骨术 骨折 压缩性 脊柱后凸 

分 类 号：R687.3[医药卫生—骨科学]