脊柱Ⅳ级截骨术治疗创伤性胸腰段后凸畸形的疗效  

Effect of grade Ⅳ osteotomy on patients with post-traumatic thoracolumbar kyphosis

作　　者：金鑫 陈政宇 关凯 孙勇伟 王劲乐 胡全文 霍红军 JIN Xin;CHEN Zheng-yu;GUAN Kai;SUN Yong-wei;WANG Jin-le;HU Quan-wen;HUO Hong-jun(Department ofOrthopedics,the First People's Hospital of Xianyang,Xianyang,Shaanxi 712000,China)

机构地区：[1]咸阳市第一人民医院骨二科,陕西咸阳712000

出　　处：《颈腰痛杂志》2022年第6期815-818,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的 探讨Ⅳ级截骨术治疗创伤性胸腰段后凸畸形(post-traumatic thoracolumbar kyphosis, PTK)的疗效。方法 回顾性分析本院于2017年9月~2020年1月开展Ⅳ级截骨术治疗的37例PTK患者临床资料,T6例,T13例,L11例,L7例;5例Frankel分级为D级,其余均为E级;本次手术与骨折发生时或首次手术的间隔时间为3~51个月,平均(16.3±5.8)个月。所有患者术后均获访24~37个月,平均(29.3±5.2)个月。结果 37例手术耗时150~230 min,平均(170.3±15.7)min;术中出血400~1100 mL,平均(661.4±130.8)mL;手术固定3~7个节段,平均(4.5±0.8)个节段。术中发生硬膜撕裂2例,予以及时修补,术后未见脑脊液漏发生;随访期间未见椎弓根钉断裂、拔出或断棒等并发症。所有截骨面均愈合,愈合时间平均4.8个月。患者术后顽固性腰痛和躯干无力、疲劳感等症状均消失或显著缓解,术前5例Frankel分级为D级者均恢复为E级;与术前相比,患者末次随访时的VAS评分、ODI指数均获显著改善(P<0.001);术后FK、TK、LL角均获显著矫正(P<0.05),且未见明显的矫正度丢失(P>0.05)。此外,SVA、PI、PT和SS角在手术前后未见显著变化(P>0.05)。结论 PTK患者经Ⅳ级截骨术可实现较理想的后凸矫形效果,减轻疼痛和功能障碍,且后期矫正丢失少,截骨面融合率高、并发症少,总体疗效满意。Objective To investigate the efficacy and orthopedic effect of grade Ⅳ osteotomy in the treatment of post-traumatic thoracolumbar kyphosis(PTK). Methods To investigate the efficacy and orthopedic effect of grade Ⅳ osteotomy in the treatment of post-traumatic thoracolumbar kyphosis(PTK). Methods The clinical data of 37 patients with PTK treated by grade Ⅳ osteotomy in our hospital from September 2017 to January 2020 were analyzed retrospectively. T6 cases, T13 cases, L11 cases, L7 cases;Frankel’s grade was D in 5 cases and the other patients were grade E. All patients were followed up for 24-37 months, with an average of(29.3±5.2)months. Results All 37 patients completed the operation successfully. The operation took 150-230 min, with an average of(170.3±15.7)min;Intraoperative bleeding was 400-1100 mL, with an average of(661.4±130.8)mL. Three to seven segments were fixed surgically, with an average of(4.5±0.8) segments. Dural laceration occurred in 2 cases, which were repaired in time. All osteotomy surfaces healed, and the healing time was 3-6 months after operation, with an average of 4.8 months. The patients’ symptoms such as intractable low back pain, trunk weakness and fatigue disappeared or significantly relieved after operation. Five patients with Frankel grade D recovered to grade E before operation. Compared with preoperation, VAS score and ODI index of patients at the last follow-up were significantly improved(P<0.001).Compared with before operation, the values of TK, FK and LL were significantly corrected in all patients after operation, and the differences were statistically significant(P<0.05). Compared with postoperation, no significant loss of correction was found in TK, FK and LL values at the last follow-up in all patients(P>0.05). In addition, the values of SVA, PI, PT and SS did not change significantly before and after operation and at the last follow-up(P>0.05). Conclusion Grade Ⅳ osteotomy in the treatment of patients with PTK can achieve ideal kyphosis correction effect, red

关 键 词：胸腰椎骨折 创伤性后凸畸形 Ⅳ级截骨术 

分 类 号：R682.13[医药卫生—骨科学]