后路经椎弓根椎体楔形截骨矫形治疗胸腰椎陈旧性骨折伴后凸畸形

Posterior transpedicular decompression and pedicle fixation for treatment of obsolete thoracolumbar vertebral fractures combined with kyphosis deformity

目的：探讨后路经椎弓根椎体楔形截骨矫形治疗胸腰椎陈旧性骨折伴后凸畸形的临床疗效。方法：回顾性分析我科于2006年1月至2010年10月收治的胸腰椎陈旧性骨折伴后凸畸形患者23例,男15例,女8例;年龄23岁至88岁;胸113例,胸127例,腰19例,腰24例;胸腰段（胸10~腰2）后凸畸形Cobb角为32°至66°,平均为46°±2.4°;伤椎后凸Cobb角为16°至42°,平均30°±1.8°。术前神经损伤程度按照ASIA分级：C级3例,D级11例,E级9例;腰背痛VAS评分平均7.84±0.28。23例患者均采用经椎弓根椎体楔形截骨矫形、减压、椎弓根钉系统内固定植骨融合手术治疗。结果：术后胸腰段后凸Cobb角平均12°±1.7°,矫正率74%;伤椎Cobb角为0°至4°,平均2.8°,矫正率91%;术后随访X片,胸腰段Cobb角矫正丢失角度不明显（2°至5°）。术后神经功能ASIA分级：3例C级2例改善至E级,1例为D级;11例D级均改善至E级;腰背痛VAS评分平均为2.9±0.13;内固定物无松动或断裂,无假关节形成等并发症。结论：后路经椎弓根椎体楔形截骨矫形治疗胸腰椎陈旧性骨折伴后凸畸形可重建胸腰段矢状面生理曲度,改善临床症状。

Objective：To discuss the clinical efficacy of posterior osteotomy and pedicle screw fixation for the treatment of old thoracolumbar vertebra fracture with kyphosis.Methods：23 patients were treated by posterior osteotomy and pedicle screw fixation in the First Affiliated Hospital of Chongqing Medical University from January 2006 to Octorber 2010,including 15 males and 8 females with an the age ranged from 23 to 88.In the 23 cases,pathological segment included T11（3 cases）,T12（7 cases）,L1（9 cases） and L2（4 cases）.All cases were provided with transpedicular subtraction osteotomy,decompression,pedicle screw internal fixation and intervertebral body fusion.The thoracolumbar cobb＇s angle was 32°-66°,mean 46°±2.4°.Injuried vertebral cobb＇s angle was 16°-42°,mean 30°±1.8°.All patients were evaluated by ASIA and VAS.According to the ASIA grading standard,the Preoperative neurological damage degree shows as follows,there were 3cases for C level,11 for D level,and 9 for E.The preoperative backpain VAS score was 7.84±0.28 point.Results： All patients＇ incision was healed without chronic infection or sinus formation.Among them,23 patients reexamined in the following 8-24 months.The postoperative mean thoracolumbar cobb＇s angle was 12°±1.7° with corrective rate 74%,and postoperative injuried vertebral cobb＇s angle was 0-4°（mean 2.8°） with corrective rate 91%.The X ray film did not find any obvious correction loss about postoperative thoracolumbar cobb＇s angle（2°-5°）.Among them,1 cases of grade C was improved to grade D and 1 to grade E,while 11 cases of grade D were improved to grade E.The preoperative VAS which was 7.84±0.28 recovered to 2.9±0.13 at final examination.The X-ray of all cases demonstrated satisfactory bone fusion and no complication,such as pseudoarticulation formation,instrument broken or loosed.Conclusion： As a selective therapy,Posterior osteotomy and pedicle screw fixation for curing old thoracolumbar vertebra fracture with kyphosis are effective both in clinical efficacy and imageology.Although the early results are promising,a long-term follow-up study is still required to prove its efficacy.