全脊椎截骨治疗陈旧性胸腰椎骨折伴侧后凸畸形

Closing wedge osteotomy to correct posttraumatic kyphotic-scoliotic deformity in thoracolumbar spine

目的探讨经后路全脊椎截骨术在治疗陈旧性胸腰椎骨折伴侧后凸畸形的应用。方法2007年3月-2009年3月应用经后路全脊椎截骨方法治疗陈旧性胸腰椎骨折伴侧后凸畸形6例。结果术中平均失血2450ml（1100-2900ml）;脊柱短缩平均1.3cm（1-1.5cm）。术后随防时间4-18个月,平均9个月。术后后凸角-5-20°,平均11.7°,矫正率67%;侧凸角1-5°,平均2°,矫正率89%。神经功能FrankelE级2例未损害;D级3例改善为E级2例,1例无变化;C级1例改善为D级。植骨愈合。随访无矫正角度丢失。结论后路全脊椎截骨术是治疗陈旧性胸腰椎骨折伴侧后凸畸形的有效方法,具有单一入路创伤小、减压彻底、容易矫形等优点。

Objective To investigate the appliance of closing wedge osteotomy in treatment of posttraumatie kyphoticscoliotic deformity in thoracolumbar spine. Methods Six cases of posttraumatic kyphotic-scoliotic deformity in thoracolumbar spine were treated by posterior closing wedge osteotomy in March 2007 to March 2009. Results The mean blood loss was 2450ml （1100 -2900ml）during operation. The mean spinal shortening was 1.3cm （1 -1. 5cm）. The average followed-up time was 9 months（4 - 18months）. After operation the kyphosis averaged 11.7°（-5 -20°）, correction rate was 67% and scoliotic deformity averaged 2°（rang 1 - 5°） ,correction rate was 89%. One case of Frankel Grade C improved Grade D,3 cases of Grade D im- proved Grade E for 2 cases and no change for one case, and there was no damage of 2 cases of Grade E. Bony fusion was achieved in all cases. The correction was not lost. Conclusion The closing wedge osteotomy was suitable to posttraumatic kyphotie-scoliotic deformity in thoracolumbar spine with a single approach,complete decompression and correcting easily.