前后路联合手术治疗胸腰段后凸成角畸形

Combined anterior and posterior approaches for correction of kyphosis of thoracolumbar spine

目的:探讨前后路联合手术矫形治疗胸腰段后凸成角畸形的效果.方法:回顾研究1998年～2003年手术治疗的18例胸腰椎后凸成角畸形患者,年龄13～56岁,平均34.0岁.14例伴有脊髓损伤,括约肌功能障碍8例,7例有显著腰背部疼痛,11例有手术史.全部病例均行前方椎体间隙松解减压植骨+后方截骨矫形固定.结果:后凸Cobb角由术前的54.8°(30°～138°)矫正至术后的14.7°(-5°～75°),矫正率41.7%～112.5%,平均为70.6%.2例于术后1年发现植骨未融合,行前后路再手术植骨融合.平均随访24.8个月(7～37个月),18例均获骨性融合,无明显矫正丢失及内固定失败.5例脊髓功能有恢复,3例括约肌功能有改善,有显著腰背部疼痛者术后疼痛均有缓解.结论:前后路联合松解矫形内固定可有效地治疗胸腰段后凸成角畸形,尤其适用于严重后凸畸形或二次手术的病例.

Objective:To evaluate the outcome of combined anterior and posterior approaches for angular kyphosis of thoracolumbar spine.Method:From 1998 to 2003,18 patients with kyphosis of thoracolumbar spine were corrected surgically.The mean age was 34.0 years(range,13~56 years).There were 14 patients with neurological deficits.Seven patients had obvious back pain.Eight patients were with sphincter dysfunction.Eleven patients had ever undergone laminectomy and/or instrumentation.The treatment procedure was combined anterior and posterior approaches.Result:Kyphosis was corrected from an average of 54.8°(range,30°~138°) to an average of 14.7°(-5°~75°),the corrective rate was 70.6%(41.7%~112.5%).Two patients had nonunion of anterior graft and required revision surgery,and achieved bony fusion afterward.The average follow-up period was 24.8 months(range,7~37 months).There were no severe complications.There was no missing of correction at the follow-up.Five of these patients showed an improvement in neural function.Sphincter function recovered partly in three patients.Back pain was relieved significantly in all seven patients.Bony fusion was achieved in all patients.Conclusion:Osteo-relaxation and internal-fixation through combined anterior and posterior approaches could correct kyphosis of thoracolumbar spine effectively,especially in patients with severe kyphosis deformity or with previous operation.