经椎弓根截骨内固定治疗陈旧性胸腰段椎体骨折后凸畸形伴椎管狭窄症的临床研究  

Transpedicular osteotomy and internal fixation in the treatment of old thoracolumbar vertebral fracture with kyphosis clinical study with spinal stenosis

作　　者：刘如月[1] 郝玉梅[2] 卢兆安[1] 周建国[1] 韩风[1] 黄久勤[1] 

机构地区：[1]河南省商丘市第一人民医院骨科,476100 [2]商丘医学高等专科学校护理系,476100

出　　处：《中国综合临床》2016年第2期171-174,共4页Clinical Medicine of China

摘　　要：目的探讨陈旧性胸腰段椎体骨折后凸畸形伴椎管狭窄症采用经椎弓根截骨内固定治疗临床效果。方法选取我院2012年6月至2014年5月收治的陈旧性胸腰段椎体骨折后凸畸形患者20例，均伴椎管狭窄症，采用经椎弓根截骨内固定治疗，观察手术时间、出血量、后凸Cobb角变化、植骨融合情况、VAS、ASIA神经功能分级评价疗效。结果手术时间为120—200min，术中出血量为800—1600ml。手术前Cobb角为（42．6±4．2）°，手术后为（8．2±1．6）°，手术前后比较差异有统计学意义（P=0．012）。术后均进行随访，随访时间10．0～26．0个月，平均（18．0±6．2）个月。VAS由术前（6．88±0．82）分降至末次随访时的（2．10±0．84）分，两者比较差异有统计学意义（P=0．023）。截骨部位均良好愈合，无假关节出现。术前ASIA分级C级6例患者，术后D级2例、E级4例；术前D级14例患者术后均转为E级。结论陈旧性胸腰段椎体骨折后凸畸形伴椎管狭窄症采用经椎弓根截骨内固定治疗操作简单，效果确切，并发症少，可有效改善预后。Objective To investigate the clinical effect of old thoracolumbar vertebral fracturekyphosis with spinal stenosis by pedicle of vertebral archosteotomy and internal fixation. Methods Twenty patients with old thoracolumbar fracture with kyphosis, and associated with spinal stenosis, were treated by using transpedibular osteotomy and internal fixation treatment in the First People,s Hospital of Shangqiu from June 2012 to May 2014. Radiographical assessments including localized kyphosis, thoracic kyphosis, lumber lordosis, sacral tilt angle, sagittal vertical axis, bony fusion and the relative height of the interbody fusion vertebra. Visual analogue scale（VAS） , and ASIA were evaluated before and after surgery, and the operative duration, blood loss were recorded. Results The operation carried out in 120-200 min, 800-1600 ml of bleeding statistics through operation process. Localized kyphosis was reduced from an average of （42. 6±4. 2）° to （8.2±1.6）°, the difference was statistically significant （P = 0. 012） . All patients were followed up for 10.0 -26.0 months,average （18.0±6.2） months. The average VAS score was 6. 88±0. 82 before operation and 2. 10±0. 84 at final follow-up, the difference was statistically significant（P= 0. 023）. The bone healed well, no false joints. Neurological function improved from C to D in 2 patients, from C to E in 4 patients, and from D to E in 14 patients. Conclusion Old thoracolumbar vertebral fracture kyphosis with spinal stenosis by transpedicularosteotomy and internal fixation in the treatment of simple operation, definite effect, less complications and can effectively improve the prognosis.

关 键 词：经椎弓根截骨内固定 陈旧性胸腰段椎体骨折 后凸畸形 椎管狭窄 

分 类 号：R683.2[医药卫生—骨科学]