胸腰椎后凸畸形合并椎间盘突出的手术治疗  

Surgical treatment of thoracolumbar kyphosis with lumbar disc herniation

作　　者：刘艳兵[1] 孙先泽[1] 任亮[1] 于金河[1] 张利民[1] 胡红涛[1] 

机构地区：[1]石家庄市第三医院脊柱外科,河北050011

出　　处：《脊柱外科杂志》2015年第5期276-279,共4页Journal of Spinal Surgery

摘　　要：目的探讨胸腰椎后凸畸形合并椎间盘突出的治疗方法。方法分析本院2007~2013年收治的38例胸腰椎后凸畸形合并椎间盘突出的患者资料。后凸≤20°采用后路全椎板切除减压、椎间植骨并Cage融合内固定术（A组,共8例）;后凸〉20°采用后方突出椎间盘摘除、经椎弓根截骨矫形内固定（B组,共30例）。采用疼痛视觉模拟量表（visual analogue scale,VAS）评分及Oswestry功能障碍指数（Oswestry disability index,ODI）评估患者疼痛和功能改善情况。采用Frankel分级评估患者神经功能状态。结果所有患者顺利完成手术,术后平均随访24个月,38例均骨性融合。A组患者术后后凸角度无变化,B组患者后凸角由术前的平均48°,改善为术后25°。2组患者VAS评分和DOI均较术前明显改善。A组Frankel C级1例恢复到D级,D级7例恢复到E级。B组Frankel C级6例恢复到D级,4例恢复到E级;Frankel D级16例恢复到E级,4例无明显变化。34例术后神经功能有改善,21例腰背痛症状明显缓解。结论根据患者的身体状况、后凸的情况选择合适的手术方式均可获得满意的疗效。Objective To evaluate the surgical approaches for the kyphosis of thoracolumbar with disc herniation.Method From 2007 to 2013,38 patients suffering from kyphosis of thoracolumbar with disc herniation were treated with surgical procedures.Group A（ kyphosis Cobb＇s angle ≤20°,8 cases） received posterior laminectomy for decompression and lumbar interbody fusion.Group B（ kyphosis Cobb＇s angle 〉20°,30 cases） received posterior diskectomy,osteotomy and internal fixation with pedicle.Visual analogue scale（ VAS） score and Oswestry disability index（ ODI） were used to evaluate the pain and functional improvement of patients.Function of spinal cord was evaluated by Frankel classification.Result All cases were followed up for 6-38 months（ average 24 months）.All patients achieved bone fusion.The Cobb＇s angle of Group A showed no change after operation,and the Cobb＇s angle of Group B was 25° in average postoperation,which improved markedly than preoperation（ 48° in average）.VAS score and ODI of 2 groups were markedly improved than that before operation.In Group A,1 case of Frankel C grade improved to D grade,7 cases of D grade improved to E grade.In group B,6cases of Frankel C grade improved to D grade,4 cases of C grade improved to E grade,16 cases of D grade improved to E grade.Function of spinal cord recovered partly in 34 cases,Back pain was relieved significantly in 21 cases.Conclusion It is necessary to evaluate each case individually.The achievement of better clinical results depends on the selection of suitable surgical treatment for the patient.

关 键 词：胸椎 腰椎 脊柱后凸 椎间盘移位 外科手术 治疗结果 

分 类 号：R682.3[医药卫生—骨科学]