胸腰段僵硬性角状后凸畸形对下腰椎的影响及外科治疗

Influence of solid thoracolumbar kyphosis on lumbar spine and surgical treatment

目的 探讨胸腰段僵硬性后凸畸形对腰椎的影响及其临床意义。 方法 测量 14例后凸畸形截骨手术治疗前后的胸腰段后凸角和L2 5、L2 ～S1、L2 3 、L3 4 、L4 5、L5～S1的前凸角以及椎体滑移的情况 ,对所得结果与正常组进行对比分析。 结果 畸形组腰椎前凸及L2 3、L3 4 、L4 5前凸角明显大于正常组 ,而且L2 3、L3 4 前凸增加幅度更大 ,术后腰椎过度前凸有明显矫正 ,但仍然大于正常组 ;畸形组有 9例 2 0个椎体向后滑移 ,70 %发生在L2、3椎体 ,术后减少至 3个 ,正常组无椎体滑移 ;前后方联合截骨矫正率为 85 7% ,单纯后方截骨矫正率为 6 0 7% ;畸形组中 8例腰背疼痛者术后 7例明显缓解或消失 ,40 %的患者括约肌功能有不同程度改善 ,5 0 %的患者肌力有不同程度改善。 结论 胸腰段后凸畸形可导致腰椎过度前凸及椎体向后方滑移 ,尤其在上腰椎更为明显 ,可能是引发腰背疼痛的重要原因之一 ;矫正胸腰段后凸畸形可减小腰椎的过度前凸和椎体滑移倾向 ,可明显减轻患者的腰背疼痛 ;前后方联合截骨更安全 ,矫正后凸畸形效果更好。

Objective To investigate the influence of solid thoracolumbar kyphosis on the lumbar spine and surgical treatment. [WT5”HZ]Methods [WT5”BZ]14 had solid kyphosis of the thoracolumbar spine. Cobb angle of kyphosis of the thoracolumbar spine and lordosis between L 2/S 1, L 2/L 5, L 2/L 3, L 3/L 4, L 4/L 5, L 5/S 1 pre and post osteotomy was measured respectively, and the amount of vertebrae slipped over 3mm was recorded. The results were compared with those of the normal group respectively. [WT5”HZ]Results [WT5”BZ]The Cobb angles of lordosis between L 2/S 1, L 2/L 5, L 2/L 3, L 3/L 4, L 4/L 5,L 5/S 1 in the deformity group were increased significantly compared with thosethat of the normal group respectively; obvious changes in percentage occurred in the segment between L 2/L 3 and L 3/L 4. Over lordosis of the lumbar spine was greatly corrected postosteotomy of the thoracolumbar spine, it was still significantly different compared with that of the normal group. In 9 patients with retrolisthesis of 20 vertebrae, 70% occurred in L 2 and L 3 vertebrae. The amount of retrolisthesis of vertebrae decreased to 3 in two patients. No retrolisthesis of vertebra was seen in the normal group. Single stage procedures combined with anterior releasing and posterior osteotomy through facet joints for kyphosis of the thoracolumbar spine showed a correction. rate of 85 7%, but single stage osteotomy through the posterior vertebra showed a correction rate of 60 7%. Seven of 8 patients who had had seriously back pain complained of no pain or slight backache after operation. 40% of the patients showed functional improvement in the sphincter of the urinary bladder and anus. 50% of the patients had improvement in muscle strength. [WT5”HZ]Conclusions [WT5”BZ]Kyphosis of the thoracolumbar spine may result in over lordosis of the lumbar spine and retrolisthesis of vertebrae, which are obvious in the upper lumbar spine. These changes may lead to back pain. Correction of kyphosis of the thoracolumbar spine may obviously decrease over lordosis of the lumbar spine and inclination of vertebral slip, and may further decrease the overload to the posterior column of the spine and relieve back pain. Osteotomy combined with anterior and posterior procedures is effective and safe in the correction of kyphosis of the thoracolumbar spine.