"Y"型截骨治疗陈旧性结核性胸腰椎重度角状后凸畸形的疗效  

Efficacy of Y type osteotomy in the treatment of severe post-tuberculous thoracolumbar kyphosis

作　　者：买尔旦·买买提[1] 牙克甫·阿不力孜 徐韬[1] 荀传辉[1] 西尔艾力·赛买提 张建[1] 曹锐[1] 邓强[1] 梁卫东[1] 盛伟斌[1] Mardan·mamat;Yakup·abliz;Xu Tao;Xun Chuanhui;Xirali·samat;Zhang Jian;Cao Rui;Deng Qiang;Liang Weidong;Sheng Weibing(Department of Spinal Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054

出　　处：《中华骨科杂志》2021年第2期84-91,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨"Y"型截骨治疗陈旧性结核性胸腰椎重度角状后凸畸形的临床疗效及其手术适应证。方法回顾性分析2012年3月至2018年6月采用"Y"型截骨治疗陈旧性结核性胸腰椎重度角状后凸畸形患者36例,男22例,女14例;年龄(23.6±5.7)岁(范围7~57岁)。后凸畸形顶椎区位于上胸椎3例、胸椎11例、胸腰段17例、腰椎5例。术前后凸Cobb角为92.8°±23.3°(范围60°~147°)。临床疗效评估采用疼痛视觉模拟评分(visual analogue scale,VAS)、美国脊柱损伤协会(American Spinal Injury Association,ASIA)神经功能分级和Kirkaldy-Willis功能评分,影像学评价指标为椎体间后凸角和脊柱骨融合情况。结果36例患者均顺利完成手术,手术时间为(210±25.9)min(范围180~270 min),术中出血量(520±110)ml(范围400~800 ml),术后随访时间为(26.38±1.75)个月(范围22~30个月)。术后后凸Cobb角矫正至16.5°±7.7°(范围5°~35°),较术前有明显改善(t=-25.438,P<0.01),矫正率为82.2%;末次随访时为16.5°±7.1°(范围6°~32°),与术后的差异无统计学意义(t=0.090,P>0.05)。术前VAS评分(7.3±1.8)分(范围3~9分),术后改善至(2.4±0.8)分(范围1~3分),VAS评分改善率为67.1%;末次随访时为(1.1±0.6)分(范围0~2分),改善率为85.0%。根据Kirkaldy-Willis功能评分标准,末次随访时优25例、良8例、中3例,优良率为91.7%。术前9例伴有神经功能障碍(ASIA分级:C级2例,D级7例),末次随访时9例患者均恢复至E级。术中2例患者神经电生理监测出现异常,1例唤醒试验阴性;另1例患者在后柱截骨后神经电生理监护提示双侧感觉、运动功能下降,检查截骨区脊髓周围无压迫,遂将手术床逐渐反折部分恢复后凸,临时双棒固定,神经电生理监护提示神经功能恢复,唤醒试验显示双下肢神经功能恢复接近术前,关闭切口,2周后再次手术行进一步截骨矫形内固定术,3个月后双下肢神经功能恢复正常。术后1例患者双下肢肌力自5级Objective To explore the clinical efficacy and surgical indications of Y type osteotomy in the treatment of post-tuberculous thoracolumbar severe angular kyphosis.Methods From March 2012 to June 2018,36 patients with post-tuberculous thoracolumbar severe angular kyphosis were treated with Y type osteotomy,including 22 males and 14 females,aged 23.6±5.7 years(range,7-57 years).The parietal vertebrae of kyphosis were located in the upper thoracic vertebra in 3 cases,the thoracic vertebra in 11 cases,the thoracolumbar segment in 17 cases,and the lumbar vertebra in 5 cases.The Cobb angle of kyphosis before the operation was 92.8°±23.3°(range,60°-147°).The visual analogue scale(VAS),American Spinal Injury Association(ASIA)neurological function grade,and Kirkaldy-Willis function score were used to evaluate the clinical effect.The imaging evaluation indexes were interbody kyphosis angle and spinal bone fusion.Results The operation was successful in all the 36 patients.The operation time was 210±25.9 min(range,180-270 min),the intraoperative blood loss was 520±110 ml(range,400-800 ml),and the postoperative follow-up time was 26.38±1.75 months(range,22-30 months).The postoperative kyphosis Cobb angle was corrected to 16.5°±7.7°(range,5°-35°),which was significantly improved compared with that before operation(t=25.438,P<0.01),and the correction rate was 82.2%.At the last follow-up,the kyphosis angle was 16.5°±7.1°(range,6°-32°),which was not significantly different from that after the operation.The preoperative VAS score was 7.3±1.8(range,3-9),and the postoperative VAS score was 2.4±0.8(range,1-3),while the improvement rate was 67.1%.At the last follow-up,it was 1.1±0.6(range,0-2),and the improvement rate was 85.0%.According to the Kirkaldy-Willis functional score,the results were excellent in 25 cases,good in 8 cases,and fair in 3 cases at the last follow-up,with an excellent and good rate of 91.7%.Before the operation,9 cases were accompanied by neurological dysfunction(ASIA grade:grade C in 2 case

关 键 词：胸椎 腰椎 结核 脊柱 脊柱后凸 截骨术 

分 类 号：R687.3[医药卫生—骨科学]