经椎弓根截骨矫形内固定术治疗陈旧创伤性脊柱胸腰段后凸畸形  

Pedicle subtraction osteotomy and internal fixation for chronic posttraumatic thoracolumbar kyphosis

作　　者：邹雄飞[1] 李其一[1] 梁锦前[1] 吴南[1] 赵宏[1] Zou Xiongfei;Li Qiyi;Liang Jinqian;Wu Nan;Zhao Hong(Department of Orthopedies,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730、China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,100730

出　　处：《中华创伤杂志》2020年第11期990-996,共7页Chinese Journal of Trauma

摘　　要：目的探讨经椎弓根截骨(PSO)矫形内固定术治疗陈旧创伤性脊柱胸腰段后凸畸形的临床疗效。方法采用回顾性病例系列研究分析2008年1月至2017年12月中国医学科学院北京协和医院及医联体医院收治的59例陈旧创伤性脊柱胸腰段后凸畸形患者临床资料,其中男39例,女20例;年龄28~67岁[(46.5±15.3)岁]。均为单节段胸腰段骨折,其中T11 3例,T12 17例,L1 34例,L2 5例。胸腰段后凸畸形Cobb角34°~65°[(43.2±5.9)°]。顽固性腰背部疼痛44例,括约肌功能部分丧失6例。脊髓损伤程度按美国脊柱损伤协会(ASIA)分级:C级5例,D级20例,E级34例。病史10~268个月[(37.4±12.5)个月]。均采用后路Ⅰ期顶椎单节段PSO矫形内固定植骨融合术。记录手术时间、术中出血量及并发症发生情况。采用视觉模拟评分(VAS)和ASIA分级评估术前及末次随访时疼痛缓解及神经功能恢复情况。评估术前、术后及末次随访时Cobb角[节段性后凸角(SK)及腰椎前凸角(LL)]、骨盆倾斜角(PT)、骶骨倾斜角(SS)和矢状面平衡等影像学指标。末次随访时采用Oswestry功能障碍指数(ODI)评估功能恢复情况。结果患者均获随访20~134个月[(46.4±14.5)个月]。手术时间为165~340 min[(203.8±34.6)min]。术中出血量为210~1 200 ml [(405.2±128.3)ml]。末次随访时无明显矫正丢失或器械失败等并发症。44例显著腰背部疼痛者,术后疼痛均不同程度缓解,VAS由术前(6.8±1.2)分降至末次随访时(1.8±0.6)分(P<0.01)。末次随访ASIA分级C级5例中有3例恢复至D或E级,D级20例中有13例恢复至E级。括约肌功能部分丧失的6例,术后自觉部分改善3例。SK由术前(43.2±5.9)°改善为术后的(5.1±1.6)°、末次随访的(5.6±1.7)°,LL由术前(11.7±3.6)°改善为术后的(48.1±4.6)°、末次随访的(46.7±3.9)°(P均<0.01),平均矫形率分别为88.2%和87.0%。PT、SS和矢状面平衡术后、末次随访时分别为(18.9±5.9)°、(28.8±9.5)°、(-2.7±2.2Objective To evaluate the outcome of pedicle subtraction osteotomy(PSO)and internal fixation for chronic posttraumatic thoracolumbar kyphosis.Methods A retrospective case series study was carried out for data of 59 patients with chronic posttraumatic thoracolumbar kyphosis admitted in Peking Union Medical Collage Hospital from January 2008 to December 2017.There were 39 males and 20 females,with the age of(46.5±15.3)years(range,28-67 years).All patients were with single-segment thoracolumbar fractures.The segment was T in 3 patients,T,in 17,L in 34,and L2 in 5.The preoperative Cobb angle of thoracolumbar kyphosis was(43.2±5.9)°(range,34°-65°).There were 44 patients with intractable low back pain and 6 patients with sphincter function disturbance.According to the American Spinal Injury Association(ASIA)grading system,5 patients were classified as Grade C,20 as Grade D and 34 as Grade E preoperatively.The duration of disease was(37.4±12.5)months(range,10-268 months).All patients underwent one-stage mono-segment posterior PSO in kyphosis vertex,internal fixation and bone graft fusion.The operation time,intraoperative blood loss,and perioperative complication were recorded.Visual analogue scale(VAS)and ASIA grading system were used to evaluate pain relief and neurological funetion recovery during follow-up.The Cobb angles for segmental kyphosis(SK)and lumbar lordosis(LL),pelvic tilt(PT),sacral slope(SS),and sagittal vertical axis(SVA)were recorded before operation,at immediately after operation,and at final follow-up.The Oswestry disability index(ODI)was used to evaluate the ffctiveness at final follow-up.Results AIll patients were followed up for(46.4±14.5)months(range,20-134 months).The operation time was 165-340 minutes[(203.8±34.6)minutes],and the blood loss volume during operation was(405.2±128.3)ml(range,210-1200 ml).Neither loss of correction nor failure of internal fixators was observed.Among the 44 patients with severe low back pain,the V AS improved from preoperative(6.8±1.2)points to(1.8±0.7)poi

关 键 词：脊柱后凸 骨折 压缩性 截骨术 胸椎 腰椎 

分 类 号：R687.3[医药卫生—骨科学]