后路截骨矫形内固定治疗胸腰段陈旧骨折合并后凸畸形

Posterior Osteotomy and Internal Fixation in Treatment of Chronic Thoracolumbar Spine Fracture and Kyphosis

目的评价后路经椎弓根楔形截骨矫形内固定术治疗胸腰段陈旧性骨折并后凸畸形的临床疗效。方法回顾性分析2003年7月至2010年7月,采用后路楔形截骨内固定术治疗胸腰段陈旧性骨折并后凸畸形患者31例,其中男21例,女10例;年龄3259岁,平均41.8岁。采用视觉模拟评分（visual analogue scale,VAS）及日本骨科协会（Japanese orthopadeics association,JOA）评分（29分法）评价临床症状的改善情况,测量X线侧位片Cobb角,评价后凸畸形的纠正和植骨融合情况。结果所有患者均获随访,随访时间662个月,平均20个月。后凸Cobb角术前平均为39.6°,术后8.4°;VAS评分术前平均7.1分,术后2.9分;JOA评分术前平均为13.6分,术后24.1分。术前术后比较差异均有统计学意义（P〈0.05）。无血管神经损伤等严重并发症发生,术后6个月植骨牢固愈合。无内固定松动、断裂等相关并发症。结论后路截骨矫形内固定术可获得满意的减压及矫形效果,同时可植骨融合,重建脊柱稳定性,并发症少,创伤较小,是胸腰段后凸畸形较理想的治疗方法。

Objective To evaluate the clinical outcome of posterior transpedicular osteotomy and internal fixation in the treatment of chronic thoracolumbar spine fracture and kyphosis.Methods From Jul 2003 to Jul 2010,a total of 31 patients with chronic thoracolumbar spine fracture and kyphosis underwent posterior transpedicular osteotomy,correction and internal fixation.There were 21 males and 10 females,and the average age was 41.8 years（range,3259 years）.The pre-and post-operative kyphotic Cobb angle,VAS of back pain,Japanese Orthopaedic Association（JOA） score,as well as the bone graft fusion and the incidence of complication were accessed.Results All patients were followed up for 662 months,with an average of 20 months.The average Cobb angle was 39.6°pre-operatively and 8.4°post-operatively.The average VAS score was 7.1 pre-operatively and 2.9 post-operatively.The mean JOA score before operation was 13.6,which was 24.1 when last follow-up.There were statistical significant differences in the above indexes between preoperation and postoperation（P〈0.05）.No postoperative complications such as artery injury,exacerbation of neurological symptoms.Bony fusion was observed after 6 months of operation,no failure of internal fixation and losing of reduction.Conclusion Posterior transpedicular osteotomy and internal fixation is a safe and feasible procedure to decompress and correct the kyphosis,also can graft and restore the stability of spine at the same time.