后路截骨矫形螺钉置入内固定修复胸腰段僵硬性角状后凸畸形:中期随访评价  

Posterior pedicle subtraction osteotomy at the apical vertebra with transpedicular instrumentation in the treatment of rigid angular kyphosis of thoracolumbar spine:a medium-term curative effects

作　　者：敖霜[1] 贾一明[1] 冷辉[1] 赵宇[2] 隋雨新[1] 张皓[1] 

机构地区：[1]内蒙古赤峰市医院脊柱外科,内蒙古自治区赤峰市024000 [2]北京协和医院骨科,北京市100000

出　　处：《中国组织工程研究》2016年第4期529-533,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81572093);项目名称:应用全外显子组测序结合代谢组学探索中国汉族人群胸椎黄韧带骨化症的致病基因~~

摘　　要：背景:脊柱矫形修复过程中主要的难点是最大限度的矫正后凸畸形同时如何减小创伤和并发症的发生,尤其是避免出现相应的脊髓神经损伤。目的:探讨后路一期顶椎或椎间隙截骨矫形及椎弓根螺钉置入内固定修复胸腰段僵硬性角状后凸畸形的方法及其中期疗效。方法:回顾性分析42例行后路一期顶椎或椎间隙截骨矫形、椎弓根螺钉置入内固定修复胸腰段僵硬性角状后凸畸形的病历资料,治疗前后患者均进行详细的影像学检查。记录所有患者治疗前后的后凸角度、Frankel分级及围手术期并发症发生情况。随访期间通过复查脊柱X射线片或CT片,了解植骨融合情况。结果与结论:治疗后随访10-36个月,植骨融合时间平均5.1个月。后凸Cobb角由治疗前的78.4°(38°-110°)矫正治疗后10 d的7°(-8°-24°)。矫正率为90%,末次随访时平均为7.9°,矫形丢失平均0.9°。16例不全瘫患者末次随访Frankel分级B级0例,C级3例,D级5例,E级8例,较治疗前获得显著改善(P<0.05)。42例患者中有5例出现并发症,其中治疗后7个月出现融合节段远端螺钉及钛棒松动1例,脑脊液漏2例,一过性双下肢无力1例,一侧下肢疼痛1例,无严重并发症发生。提示后路一期顶椎或椎间隙截骨矫形及椎弓根螺钉置入内固定修复胸腰段僵硬性角状后凸畸形可获得良好的矫形效果,内固定牢固,融合率高,并发症较少,中期随访效果较满意。BACKGROUND： During spinal orthopedic repair, the main difficulty is to maximize the correction of the deformity, simultaneously, to reduce the incidence of trauma and complications, especially to avoid the corresponding spinal nerve injury. OBJECTIVE： To evaluate the curative effect of one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation in the treatment of rigid angular kyphosis of thoracolumbar spine. METHODS： We retrospectively analyzed the data of 42 cases of rigid angular kyphosis of thoracolumbar spine that were treated by one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation. All patients received detailed imaging examination before and after operation. Kyphosis angle, Frankel grading and perioperative complications were recorded in all patients. X-ray films or CT films showed the bone graft fusion during follow-up. RESULTS AND CONCLUSION： Patients were followed up for 10-36 months after treatment. The average time of bone graft fusion was 5.1 months. Cobb＇s angle of kyphosis was corrected from 78.4°（38°-110°） preoperatively to 7°（-8°-24°） at 10 days after treatment. The correction rate was 90%. The average angle during final follow-up was 7.9°, with an average loss of 0.9°. In 16 paresis patients, Frankel grading results showed grade B in 0 case, grade C in 3 cases, grade D in 5 cases, and grade E in 8 cases during final follow-up, showing significant improvement as compared with that pre-treatment（P〈0.05）. Among 42 patients, 5 cases had complications. At 7 months after treatment, there were screw and titanium rod loosening at the distal end of the fusion segment in 1 case, cerebrospinal fluid leakage in 2 cases, transient double lower limb weakness in 1 case, pain in one side of lower limb in 1 case, and no severe complications appeared. These results verified that one-stage posterior pedicle subtraction osteotomy of apical vertebra with transpedicular instrumentation cou

关 键 词：脊柱后凸 内固定器 随访研究 组织工程 骨科植入物 脊柱植入物 截骨矫形 胸腰段 椎弓根内固定 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]