后路截骨矫形仿生骨植骨融合内固定治疗胸腰椎Kummell病并后凸畸形  

Magnified pedicle subtraction osteotomy via posterior approach combined with biomimetic bone graft fusion and internal fixation for thoracolumbar Kummell disease and kyphosis

作　　者：焦云龙[1] 潘玉林[1] 郭小伟[1] 孟庆勇[1] 张怀栓[1] 杨广辉[1] 

机构地区：[1]郑州市骨科医院脊柱二科,郑州450052

出　　处：《中华创伤骨科杂志》2017年第12期1093-1098,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的观察后路截骨矫形加仿生骨植骨融合内固定治疗胸腰椎Kummell病并后凸畸形的疗效。方法回顾性分析自2012年3月至2016年6月经由后路扩大式经椎弓根截骨（mPSO）加仿生骨cage植骨融合内固定手术治疗的11例胸腰椎Kummell病并后凸畸形患者资料，男3例，女8例；平均年龄61．2岁；术前及术后2周、1个月、3个月、6个月、12个月分别以视觉模拟评分（VAS）、日本骨科协会（JOA）评分、美国脊髓损伤协会（ASIA）损伤分级进行评估。结果所有患者术后获10～13个月（平均11．4个月）随访。术后2周、末次随访时的VAS评分[（2．1±0．5）分、（1．1±0．2）分]、JOA评分[（23．6±3．8）分、（25．5±3．2）分]、cobb角（8．1°±1．5°、13．8°±2．1°）分别与术前[（8．1±0．6）分、（12．1±3．6）分、51．3°±9．8°]比较差异均有统计学意义（P〈0．05），但术后2周和末次随访时间比较差异均无统计学意义（P〉0．05）。ASIA分级末次随访结果：1例由术前C级改善至术后D级，3例由术前D级改善至术后E级；末次随访时患者植骨区均可见骨眭融合，融合率为100％。结论对于进展至合并后凸畸形的胸腰椎Kummell病患者，后路截骨矫形加仿生骨植骨融合内固定手术治疗可以取得良好的疗效。Objective To observe the clinical effects of magnified pedicle subtraction osteotomy （mPSO） via the posterior approach combined with biomimetic bone graft fusion and internal fixation for the treatment of thoracolumbar Kummell＇s disease and kyphosis. Methods A total of 11 patients with thoracolumbar Kummell＇s disease and kyphosis deformity were treated at our department from March 2012 to June 2016. They all underwent mPSO via the posterior approach combined with biomimetic bone graft fusion and internal fixation. They were 3 men and 8 women with an average age of 61.2 years. The clinical effects were evaluated according to visual analogue scale （VAS）, Japanese Orthopaedic Association （JOA） scoring, American Spinal Injury Association （ASIA） grading, cobb angle correction and rate of bone graft fusion at preoperation and 2 weeks, 1, 3, 6 and 12 months after operation. Results All the patients were followed up for an average of 11.4 months （from 10 to 13 months） . The VAS scores （2. 1 ±0.5 points and 1. 1 ±0.2 points）, JOA scores （23.6 ± 3.8 points and 25.5 ± 3.2 points） and cobb angles （8. 1° ±1.5° and 13.8°± 2. 1°） at 2 weeks after operation and final follow-ups were significantly improved from their preoperative values （8.1 ± 0.6 points, 12. 1 ± 3.6 points and 51.3 ° ±9. 8°, respectively） （ P 〈 0. 05） . However, there were no significant differences between 2 weeks after operation and the final follow-up in terms of the above values （ P 〉 0. 05 ） . The ASIA grading was improved from preoperative grade C to postoperative grade D in one case, and from preoperative grade D to postoperative grade E in 3 cases. At final follow-ups, bony fusion was observed at all the bone graft sites, with a fusion rate of 100%. Conclusion mPSO via the posterior approach combined with biomimetic bone graft fusion and internal fixation is a good treatment for patients with thoracolumbar Kummell＇s disease and kyphosis deformity.

关 键 词：胸椎 腰椎 截骨术 Kummell病 后凸畸形 

分 类 号：R687.3[医药卫生—骨科学]