后路截骨矫形长节段固定治疗老年性胸腰段后凸畸形

Posterior osteotomy and long-segment internal fixation for the treatment of senile thoracolumbar kyphotic deformity

目的:探讨后路截骨矫形长节段固定治疗老年性胸腰段后凸畸形的疗效,为老年性胸腰段后凸畸形的外科治疗提供参考。方法:对2007年4月至2010年4月手术治疗的19例老年性胸腰段后凸畸形的临床资料进行回顾性分析,男12例,女7例;年龄58～74岁,平均62岁;陈旧性骨折11例,强直性脊柱炎3例,脊柱陈旧结核5例。术前神经功能Frankel分级:E级12例,D级4例,C级2例,B级1例。19例患者均采用后路经顶椎截骨矫形长节段内固定术,均进行至少1年以上随访。分析内容包括术前、术后2周及术后1年患者疼痛VAS评分,后凸Cobb角,神经功能和术后并发症。结果:19例患者术前、术后2周、术后1年VAS评分分别为(7.0±1.2)、(1.1±0.7)、(1.3±0.8)分,后凸Cobb角分别为(44.1±6.9)、(10.9±3.1)、(11.5±2.8)°;VAS评分和后凸Cobb角术前与术后2周比较,差异均有统计学意义(P<0.05),术后2周与术后1年比较,差异均无统计学意义(P>0.05)。末次随访时18例(94.7%)符合骨性融合的标准,1例于术后1年截骨面未完全融合,但未出现内固定松动现象。神经症状:D级4例中有3例恢复至E级;C级的2例恢复至D级;B级1例恢复至C级。结论:后路截骨矫形长节段固定术治疗老年胸腰段后凸畸形,可取得良好的近期疗效。

Objective：To explore the therapeutic effects of posterior osteotomy and long-segment internal fixation in the treatment of senile thoracolumbar kyphotic deformity and provide the reference for operative treatment.Methods：From April 2007 to April 2010,19 older patients with thoracolumbar kyphotic deformity were respectively analyzed.There were 12 males and 7 females with an average age of 62 years（ranged,58 to 74 years）.Among patients,11 cases were old fracture,3 cases were ankylosing spondylitis,and 5 cases were old spinal tuberculosis.According to preoperative Frankel classification,12 cases were grade E,4 cases were grade D,2 cases were C and 1 case was grade B.All patients were treated by posterior osteotomy and long-segment internal fixation and followed up above 1 year.VAS score preoperative,2 weeks and 1 year after operation,Cobb＇s angle,nerve function and complication were observed.Results：VAS score preoperative,2 weeks and 1 year after operation separately was（7.0±1.2）,（1.1±0.7） and（1.3±0.8）;while Cobb＇s angle separately was（44.1±6.9）,（10.9±3.1） and（11.5±2.8）;there was significant difference in VAS score and Cobb＇s angle between preoperative and 2 weeks after operation（P0.05）;while no significant difference between 2 weeks and 1 year after operation（P0.05）.Eighteen cases met the standard of osseous fusion,1 case occurred nonunion,but not looseness 1 year after operation.Nerve function：3 cases changed grade E from 4 cases with grade D,2 cases with grade C changed to grade D,1 case with grade B changed to grade C.Conclusion：Posterior osteotomy and long-segment internal fixation for the treatment of senile thoracolumbar kyphotic deformity can receive a good short-time effects.