保留中柱经椎弓根截骨术治疗陈旧性胸腰段骨折伴后凸畸形的疗效  

Efficacy of middle-column preserved pedicle subtraction closing-opening wedge osteotomy in treatment of old thoracolumbar fractures combined with kyphosis deformity

作　　者：郑光彬[1] 洪正华 陈遥 褚斌翔 王章富 冯兴兵 陈伟富 陈海啸[1] Zheng Guangbin;Hong Zhenghua;Chen Yao;Chu Binxiang;Wang Zhangfu;Feng Xingbing;Chen Weifu;Chen Haixiao(Department of Spine Surgery,Taizhou Hospital,Zhejiang University,Taizhou 317000,China)

机构地区：[1]浙江大学台州医院脊柱外科,317000

出　　处：《中华创伤杂志》2020年第4期303-308,共6页Chinese Journal of Trauma

基　　金：浙江省公益技术研究计划(LGF18H060012);恩泽医疗中心科学研究基金(EZ2017ZDA02)。

摘　　要：目的探讨保留中柱经椎弓根开合式截骨术矫正陈旧性胸腰段骨折后凸畸形的临床疗效。方法采用回顾性病例系列研究分析2010年1月—2017年1月浙江大学台州医院收治的27例陈旧性胸腰段骨折后凸畸形患者的临床资料,其中男10例,女17例;年龄45~75岁,平均61.7岁。损伤及截骨节段:T115例,T1210例,L18例,L24例。初次骨折至手术时间9~120个月,平均23.2个 月。9例有神经损害症状,根据美国脊髓损伤协会(ASIA)分级:C级1例,D级8例。均行保留中柱经椎弓根开合式截骨术治疗。记录手术时间、术中出血量及围术期并发症等情况。在术前、术后3个月及末次随访时测量局部后凸畸形Cobb角、矢状面平衡(SVA)、截骨椎前柱高度(AC)及后柱高度(PC)评价矫形效果;采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评价临床疗效;采用ASIA分级评价神经功能改善情况。结果患者均获随访12~34个月,平均18.1个月。手术时间130~250 min[(155.2±35.4)min],术中出血量150~550 ml[(338.1±101.4)ml]。所有患者围术期未出现严重神经或血管并发症。术后3个月后凸Cobb角[(6.0±3.1)°]与术前[(46.5±8.5)°]比较差异有统计学意义(P<0.05),与末次随访时Cobb角[(7.9±3.8)°]比较,矫正无明显丢失(P>0.05)。术后3个月SVA由术前[42.7(25.5,78.2)]mm矫正为[5.5(1.2,7.3)]mm(P<0.05),截骨椎AC较术前平均增加16.3 mm(P<0.05),而PC则无显著改变(P>0.05);末次随访与术后3个月比较差异均无统计学意义(P>0.05)。术后3个月及末次随访时VAS[(1.7±0.8)分、(2.3±1.4)分]和ODI(17.3±7.5、19.4±4.3)较术前[(7.7±1 3)分、61.4±6.2]均有明显改善(P<0.05),末次随访与术后3个月比较差异无统计学意义(P>0.05)。所有患者随访期间无内固定失败发生,且术后6个月随访时即可见截骨面均已达到骨性融合。末次随访时,1例术前ASIA分级C级患者已恢复至D级,8例ASIA分级D级患者恢复至E级。结论保留中柱�Objective To investigate the effect of middle-column preserved pedicle subtraction closing-opening wedge osteotomy for the treatment of old thoracolumbar compression fractures combined with kyphosis deformity.Methods A retrospective case series study was performed to analyze data of 27 patients with old thoracolumbar compression fractures combined with kyphosis deformity admitted in Taizhou Hospital from January 2010 to January 2017.There were 10 males and 17 females,with age range of 45-75 years(mean,61.7 years).The injured segments and osteotomy segments included T11 in 5 patients,T12 in 10,L1 in 8 and L2 in 4.Time from initial fracture to surgery was 9-120 months(mean,23.2 months).According to the American Spinal Injury Association(ASIA)classification,neurological impairment symptoms were detected in 9 patients,including grade C in 1 and grade D in 8.All patients underwent one-level middle-column preserved pedicle subtraction osteotomy.Operation time,blood loss,and perioperative complications were recorded.Before operation,at 3 months after operation and at latest follow-up,kyphosis Cobb angle,sagittal vertical axis(SVA)and height of anterior column(AC)as well as posterior column(PC)were measured.Visual analogue scale(VAS)and Oswestry disability index(ODI)score were used to evaluate the clinical efficacy.American Spinal Injury Association(ASIA)score was used to assess neurological function.Results All patients were followed-up for average 18.1 months(range,12-34 months).Operation time was(155.2±35.4)minutes(range,130-250 minutes).Blood loss was(338.1±101.4)ml(range,150-550 ml).No serious neurological or vascular complications occurred during perioperative period.Kyphosis Cobb angle was(6.0±3.1)°at postoperative 3 months compared to preoperative(46.5±8.5)°(P<0.05),and showed no significant loss at latest follow-up[(7.9±3.8)°](P>0.05).SVA was improved significantly from preoperative[42.7(25.5,78.2)]mm to[5.5(1.2,7.3)]mm at postoperative 3 months(P<0.05).AC height was increased by average 16.3 mm at posto

关 键 词：脊柱骨折 脊柱后凸 截骨术 

分 类 号：R687.3[医药卫生—骨科学]