经后路伤椎植钉椎间撑开Cage植入治疗陈旧性胸腰椎骨折后凸畸形  

TREATMENT OF THORACOLUMBAR KYPHOSIS CAUSED BY OLD FRACTURE USING PEDICAL SCREW AT THE FRACTURE LEVEL, INTERVERTEBRAL DISTRACTION, AND CAGE INSERTION BY POSTERIOR APPROACH

作　　者：付松[1] 邵诗泽[1] 孙秀琛[1] 侯海涛[1] 刘海军[1] 王龙强[1] 王欢[1] 黄相鹏[1] 吕仁花[2] 

机构地区：[1]文登整骨医院脊柱脊髓科,山东文登264400 [2]威海市文登中心医院神经内科

出　　处：《中国修复重建外科杂志》2013年第10期1221-1224,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价经后路伤椎植钉椎间撑开Cage植入治疗陈旧性胸腰椎骨折后凸畸形的近期临床疗效。 方法2008年6月－2010年6月，采用后路伤椎植钉椎间撑开Cage植入治疗陈旧性胸腰椎骨折后凸畸形15例。其中男9例，女6例；年龄39～65岁，平均54.6岁。病程5个月～3年，平均1.5年。骨折节段：T11 1例，T12 4例，L1 5例，L2 5例。10例合并神经症状，按美国脊髓损伤协会（ASIA）分级为B级4例、C级3例、D级3例，其中3例伴性功能、括约肌功能障碍。术前后凸Cobb角为（47.4 ± 10.2）°，Oswestry功能障碍指数（ODI）评分为67.9% ± 6.9%，疼痛视觉模拟评分（VSA）为（8.6 ± 1.4）分。 结果术后切口均Ⅰ期愈合。15例均获随访，随访时间13～60个月，平均28个月。X线片示椎间均获骨性融合，融合时间6～11个月，平均10.2个月。随访期间内固定物无松动、断裂。患者后凸畸形均明显矫正，腰背部疼痛症状缓解。术后1年后凸Cobb角矫正至（13.3 ± 7.7）°，ODI评分为25.2% ± 4.6%，VAS评分为（2.3 ± 0.6）分，均较术前显著改善（t=72.80，P=0.00；t=48.04，P=0.00；t=26.52，P=0.00）。10例术前伴脊髓损伤者术后ASIA分级恢复1级以上者8例，其中3例B级恢复至C级，3例C级恢复至D级，2例D级恢复至E级；3例伴性功能、括约肌功能障碍均有不同程度恢复。 结论经后路伤椎植钉椎间撑开Cage植入治疗陈旧性胸腰椎骨折后凸畸形，能有效矫正后凸畸形，缓解临床症状，近期疗效满意。ObjectiveTo evaluate the effectiveness of using pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach to treat thoracolumbar kyphosis caused by old fracture. MethodsBetween June 2008 and June 2010, 15 cases of thoracolumbar kyphosis caused by old fracture were treated with pedical screw at the fracture level, intervertebral distraction, and Cage insertion by posterior approach. There were 9 males and 6 females with a mean age of 54.6 years （range, 39-65 years）. The disease duration was 5 months to 3 years with an average of 1.5 years. Fractured segments included T11 in 1 case, T12 in 4 cases, L1 in 5 cases, and L2 in 5 cases. Ten patients had nerve symptom, according to American Spinal Injury Association （ASIA） grading, 3 cases were classified as grade B, 4 cases as grade C, and 3 cases as grade D, of which 3 cases had sexual and sphincter dysfunction. At preoperation, the Cobb angle was （47.4 ± 10.2）°; the Oswestry disability index （ODI） score was 67.9% ± 6.9%; and the visual analogue scale （VSA） was 8.6 ± 1.4. ResultsThe wounds obtained primary healing. The mean follow-up time was 28 months （range, 13-60 months）. X-ray films showed intervertebral bone fusion was obtained within 6-11 months （mean, 10.2 months）. No fixation loosening or breaking occurred during follow-up. Kyphosis was corrected, and lumbar back pain was relieved. At 1 year after operation, Cobb angle was significantly corrected to （13.3 ± 7.7）° （t=72.80, P=0.00）; ODI score was significantly improved to 25.2% ± 4.6% （t=48.04, P=0.00）; VAS score was significantly decreased to 2.3 ± 0.6 （t=26.52, P=0.00）. According to ASIA grading in 10 patients with spinal cord injury, the spinal cord function was improved by 1 grade in 8 cases （3 cases from grade B to C, 3 cases from grade C to D, and 2 cases from grade D to E）; 3 patients with sexual and sphincter dysfunction recovered in different degrees. ConclusionUsing pedical screw at the fracture leve

关 键 词：陈旧性胸腰椎骨折 伤椎植钉 胸腰椎后凸畸形 

分 类 号：R687.3[医药卫生—骨科学]