改良后路单侧椎体次全切截骨矫形术治疗陈旧性胸腰椎骨折伴后凸畸形  

Modified posterior unilateral subtotal corpectomy osteotomy correction for old thoracolumbar vertebral fractures combined with kyphosis

作　　者：张锴 高延征[1] 邢帅[1] 曹臣[1] 赵亮[2] 王耀斌 陈书连[1] Zhang Kai;Gao Yanzheng;Xing Shuai;Cao Chen;Zhao Liang;Wang Yaobin;Chen Shulian(Department of Spine and Spine Cord Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Orthopedics,First People's Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院脊柱脊髓外科,郑州450003 [2]郑州市第一人民医院骨科,450000

出　　处：《中华创伤杂志》2019年第8期708-715,共8页Chinese Journal of Trauma

基　　金：河南省医学科技重点攻关项目(201502024);河南省科技厅基础与前沿项目(1221102310145).

摘　　要：目的探讨改良后路单侧椎体次全切截骨矫形术治疗陈旧性胸腰椎骨折伴后凸畸形的临床效果.方法采用回顾性病例系列研究分析2012年1月-2016年10月河南省人民医院收治的18例陈旧性胸腰椎骨折伴后凸畸形患者的临床资料,其中男10例,女8例;年龄25~70岁,平均38.2岁.损伤及截骨节段:T111例,T124例,L16例,L27例.5例有神经损害症状,按Frankel分级为D级.均行改良后路单侧椎体次全切截骨矫形治疗.记录手术时间及术中出血量.比较术前、术后半年及末次随访时后凸Cobb角、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI).采用Suk标准评价截骨融合情况,采用Frankel分级评估神经功能恢复情况,观察并发症发生情况.结果患者均获随访12~24个月,平均17.6个月.手术时间160~285min[(190.0±42.6)min],术中出血量500~800ml[(610.0±134.3)ml].术后半年Cobb角[(5.5±1.6)°]与术前[(40.5±9.8)°]差异有统计学意义(P<0.05),末次随访时Cobb角[(6.2±1.5)°]较术后半年无明显丢失(P>0.05).术后半年及末次随访时VAS[(3.1±1.3)分、(2.7±0.7)分]和ODI(7.5±5.1、6.4±2.5)较术前[(7.6±2.4)分、68.7±10.4]均有明显改善(P<0.05),末次随访与术后半年比较差异无统计学意义(P>0.05).截骨面均达到骨性融合.术前存在神经功能损害的5例患者,末次随访时Frankel评分均改善至E级.术中出现硬脊膜破裂2例,胸腔积液1例,未出现神经损害、感染及血栓形成等并发症.随访过程中无内固定松动、断裂或异位骨化发生.结论改良后路单侧椎体次全切截骨矫形术治疗陈旧性胸腰椎骨折伴后凸畸形既可达到伤椎与相邻椎体的骨性融合又避免脊柱短缩,能够矫正胸腰椎后凸畸形、缓解疼痛及改善神经功能,并发症发生率低.Objective To evaluate the efficacy of modified posterior unilateral subtotal corpectomy osteotomy correction for old thoracolumbar vertebral fractures combined with kyphosis. Methods A retrospective case series study was conducted to analyze 18 patients with old thoracolumbar vertebral fractures combined with kyphosis admitted to the Henan Provincial People's Hospital from January 2012 to October 2016. There were 10 males and eight females, aged 25-70 years, with an average age of 38. 2 years. The injured segments and osteotomy segments included T11 in one patient, T12 in four, L1 in six, and L2 in seven. Five patients had neurological impairment symptoms classified as grade D according to Frankel's classification. All patients underwent the modified posterior unilateral subtotal corpectomy osteotomy correction. The operation time and intraoperative blood loss were recorded. The visual analogue score (VAS), Oswestry dysfunction index (ODI) and kyphosis Cobb angle were compared before operation, half a year after operation and at the last follow-up. The osteotomy fusion was evaluated by Suk criterion and Frankel grading was used to evaluate the recovery of nerve function. The complications were also recorded. Results All patients were followed up for 12-24 months, with an average of 17. 6 months. The operation time was 160-285 minutes [(190. 0 ± 42. 6) minutes, and the intraoperative blood loss was 500-800 ml [(610. 0 ± 134. 3) ml]. The difference of kyphosis Cobb angle between preoperative [(40.5±9.8)°] and [(5.5 ±1.6)°] at 6 months postoperatively had statistical significance (P <0. 05). Compared with the kyphosis Cobb angle of 6 months postoperatively [(5. 5 ± 1. 6)°], the Cobb angle at the final follow-up [(6. 2 ± 1. 5)°] did not change significantly (P>0. 05). The VAS score and ODI at 6 months after operation and at the final follow-up [(3. 1 ± 1. 3)points,(2. 7 ± 0. 7)points and 7. 5 ± 5. 1, 6. 4 ± 2. 5] were significantly different compared with those before operation [(7. 6 ± 2. 4)points, 68

关 键 词：胸椎 腰椎 脊柱骨折 脊柱后凸 后路全椎体切除术 

分 类 号：R687.3[医药卫生—骨科学]