经后路椎弓根截骨短节段椎弓根钉内固定治疗脊柱后凸畸形

TREATMENT OF KYPHOSIS DEFORMITY WITH PEDICLE SUBTRATION OSTEOTOMY AND SHORT-SEGMENT PEDICLE SCREW INTERNAL FIXATION

目的 探讨经椎弓根单椎体截骨短节段椎弓根钉内固定治疗脊柱后凸畸形的临床疗效。方法 2001年6月～2003年11月，采用经后路椎弓根截骨短节段椎弓根钉内固定治疗16例脊柱后凸畸形患者。其中男11例，女5例，年龄24～51岁。强直性脊柱炎12例，陈旧性胸腰椎骨折脱位伴不完全截瘫2例，椎体发育不良2例。病程7～25年，平均12．8年。手术前、后均行脊柱全长X线片检查，测量胸椎后凸角、腰椎前凸角、骶骨水平角及骶骨后上角至脊柱矢状轴线的距离，评定植骨愈合情况、内固定位置及手术并发症。按Bridwell—Dewald脊柱疾患疼痛及功能评定标准进行手术前后疗效评价。结果 术中出血700～2000ml，平均1100ml；术中硬脊膜破裂1例；术后发生麻痹性肠梗阻1例，下肢短暂性麻痹2例。术后获随访18～35个月，平均25．6个月。植骨愈合满意，无延迟愈合或不愈合。最后随访时，腰椎前凸角从术前9．6±16．4°，矫正至术后42．6±14．3°（P〈0．05），平均矫正角度为33°；骶骨水平角的改变与此类似。胸椎后凸角手术前后改变不明显，而骶骨后上角至脊柱矢状轴线的距离由术前97．5±45．6mm降至术后10．7±9．6mm（P〈0．05）。术后疼痛、工作及社交情况较术前都有明显改善。结论 经后路椎弓根椎体截骨短节段椎弓根钉内固定治疗脊柱后凸畸形，矫正度数大，手术相对安全，可取得较理想的放射学矫形效果及临床疗效。

Objective To assess the outcomes of pedicle subtration osteotomy and short-segment pedicle screw internal fixation in kyphosis deformity. Methods From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtration osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracture-dislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8 years. The whole spine radiographs were taken pre- and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, sacrohorizontal angle and distance between posterosuperior point of S1 and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders. Results The mean follow-up period was 25.6 months. The mean bleeding was 1 100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6± 16.4° to 42.6± 14.3°（P〈0.05）, whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5± 45.6 mm to 10. 7 ±9.6 mm（P〈0.05）. Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status. Conclusion Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.