经椎弓根闭合楔形截骨术矫正胸腰椎后凸畸形的3年随访

Three Years follow-up on Pedicle subtraction osteotomy in the treatment of thoracolumbar kyphotic deformity

目的：评估经椎弓根闭合楔形截骨术矫正胸腰椎后凸畸形的临床疗效。方法：2002年1月～2009年12月,45例胸腰椎后凸畸形患者进行经椎弓根闭合楔形截骨矫形术。其中强直性脊柱炎18例,陈旧性胸腰椎骨折15例,胸腰椎结核12例。所有患者均得到随访,内容包括术前、术后Cobb角以及侧位片上C7~S1水平距离,截骨处融合情况,腰痛视觉模拟评分（VAS）和Oswestry功能评分（ODI）的变化。结果：平均随访时间为36个月。平均手术时间为220分钟,术中平均出血量为1510ml。术前后凸Cobb角平均为50.8°,术后为11.5°,平均矫正角度36.5°,C7~S1水平距离术前平均110.5mm,术后平均为20.8mm。融合率100%。术前患者腰痛VAS评分平均为7.9分,术后2.8分。术前ODI评分平均为62.3分,术后为29.5分。患者主观满意率97%。2例出现术后神经根损伤症状,未经特殊处理均基本恢复正常。2例术后出现脑脊液漏,经缝合、压迫治愈。结论：经椎弓根截骨术矫正胸腰椎后凸畸形有效、安全,应该进行个体化治疗,根据患者的实际情况选择合适的截骨部位。

Objective： To evaluate the efficacy of the pedicle subtraction osteotomy（PSO） in the treatment of thoracolumbar kyphotic defonnity.Methods：Fouty-five patients of thoracolumbar kyphosis underwent PCWO from January 2002 to December 2009, among which were 18 cases ofankylosing spondylitis, 15 cases of post traumatic kyphosis and 12 cases of spine tuberculosis. Pre and post operative kyphotic Cobb angle and the horizontal distance between the C7 and S1 on the lateral view, the fusion of osteotomic site, VAS of back pain, Oswestry Disablity Index, as well as the incidence of complication were accessed. Results： Mean follow up duration was 36 months. Average operative time was 220 rain and average bleeding was 1510 ml. Average Cobb angle was 50.8° preoperatively and 11.5° postoperatively, with a mean correction of 36.5° , The horizontal distance between the C7 and S1 was 110.5mm and 20.8 mm respectively before and after operation. The fusion rate was 100%. Average VAS of back pain was 7.9 preoperatively and 2.8 postoperatively. Average ODI was 62.3 preoperatively and 29.5 postoperatively. Rate of satisfaction was 97 %, Complications were encountered in 4 patients, 2 with transient nerve root injuries and 2 with leakage of cerebrospinal fluid postoperatively and the 4 cases recovered in no times.conclusion：Pedicle Subtraction Osteotomy is an effective and safe method to correct the thoracolumbar kyphosis, individual treatment and personalized choice of osteotomy level is critical.