椎体切除截骨矫形术治疗胸腰段脊柱后凸的疗效观察

Therapeutic effect of vertebral column resection on the thoracolumbar kyphotic deformity

目的观察椎体切除截骨矫形术治疗胸腰段脊柱后凸的矫正效果。方法2004年8月至2008年7月,采用后路椎体切除截骨矫形椎弓根钉棒固定植骨融合术治疗15例脊柱后凸患者,男10例,女5例;年龄12～62岁,平均32.3岁;后凸角度45°～110°,平均78.5°。病因:椎体肿瘤术后3例,先天性脊柱畸形5例,创伤后脊椎后凸4例,椎体结核术后3例。受累节段:均位于胸腰段,T_(11) 3例,T_(12) 5例,L_1 5例,L_2 2例。椎体切除:部分切除4例,单节段切除8例,2节段切除2例,4节段切除1例。术前,术后1周、3个月、1年摄全脊柱X线片,同时行MR及CT检查。结果全部获得随访,随访时间为10个月～3年,平均26个月。术后后凸角为0°～40°,平均20°,平均改善68.5°。术后患者腰痛均消失。脊髓功能:13例E级无明显变化,1例由Frankel C级恢复至D级,另1例由D级恢复至E级。8～12个月X线片示截骨融合,无一例出现钉棒松动、断裂、假关节形成及矫正度数丢失等。结论椎体切除截骨矫形是治疗脊柱后凸畸形的有效手段,能达到矢状面和冠状面的同时矫正且矫形彻底。

Objective To retrospectively assess the effect of vertebral column resection for correction of thoracolumbar kyphotic deformity.Methods Between August 2004 and July 2008,15 patients with severe kyphosis（average Cobb＇s angle is 78.5°,ranged 45°-110°）were treated by the technique of vertebral column resection and pedicle screw fixation via a posterior-only approach.There were 10 males and 5 females with an average age of 32.3 years（range, 12-62）.There were 3 cases of vertebral tumor course,5 cases of congenital spine malformation,4 cases of kyphosis after injury and 3 cases of tuberculosis of spine after operation.The involved vertebral bodies were all located on thoracic waist（T_（11）in 3,T_（l2）in 5,L_1 in 5,L_2 in 2）.X-ray,MRI,computed tomography were taken as the measurement at the time of preoperation,1 week after the operation and one year later,respectively.The changes of Cobb＇s angle,neurologic symptoms and fusion of the fixed segment were compared.Results The average time of followup is 26 monthes（ranged from 10 month to 3 years）.The mean of the postoperative and preoperative Cobb＇s angle is 20o（0-40°）and 78.5°（45-110°）,respectively,and the number of improvement averaged 68.5°.The pain of back disappeared in all of the cases.The assessment of the function of neurologic system was improved from C to D in one patient and D to E in another one as the Frankel classification.X-ray showed that bones were fused 8-12 months posoperatively.There was no loosening of screw,breakdown of rod,pseudoarthrodesis and lose of correction.Conclusion Vertebral column resection is an efficient technique for the treatment of thoracolumbar kyphotic deformity.The deformity could be corrected thoroughly in both sagittal and coronal plane,while this procedure may cause large trauma for patients and increase the risks of damage to nerves and even spinal cord.