扩大“蛋壳”结合闭合-张开技术治疗胸腰椎角状后凸畸形

Expanded eggshell and closing-opening procedure of the treatment for thoracolumbar angular kyphosis

目的：总结扩大＂蛋壳＂结合闭合-张开技术治疗胸腰椎角状后凸畸形的手术疗效。方法：2009年12月~2012年2月采用扩大＂蛋壳＂结合闭合-张开技术治疗13例胸椎及胸腰段角状后凸畸形患者,男8例,女5例;年龄15~47岁,平均33.5岁;完全分节后方半脊椎畸形3例,陈旧性胸椎及腰椎骨折后凸畸形6例,陈旧性脊柱结核后凸畸形4例（其中1例为T3~T5畸形愈合）。后凸顶椎部位：T3~T5 1例,T7/8 1例,T8/9 1例,T11/121例,T12 4例,L1 5例。10例病变节段位于T11~L1水平者均存在严重腰背部疼痛,VAS评分8~10分,平均8.7±1.1分;3例胸段后凸畸形者均合并神经功能障碍,Frankel C级2例,D级1例。术前局部后凸角度62.0°~75.0°,平均67.3°。采用扩大＂蛋壳＂结合闭合-张开技术矫正后凸畸形,观察术后症状改善及畸形矫正情况。结果：患者均顺利完成手术,手术时间400±60min,术中失血为960±120ml。术中无节段血管、神经损伤,无硬膜撕裂、胸膜破裂和/或血气胸等并发症。术后局部后凸角矫正至18.0°~24.5°,平均20.3°±2.5°,平均矫正率为68.7%。所有患者术后均获得随访,随访时间24~36个月,平均29.6个月,末次随访时后凸角为19.0°~24.2°,平均21.0°±3.3°,与术后比较无显著性差异（P〉0.05）;无矢状面失平衡者。术前胸背部疼痛患者VAS评分改善至2.1±1.9分,与术前比较有显著性差异（P〈0.05）。术前2例Frankel C级患者1例恢复至D级、1例恢复至E级,1例D级患者恢复至E级。随访期间无内固定器械松动、断裂等并发症,植骨均融合。结论：扩大＂蛋壳＂结合闭合-张开技术治疗胸腰椎角状后凸畸形手术相对安全,矫正率较高,疗效可靠。

Objectives： To determine the efficacy of combined expanded eggshell and closing-opening proce- dure of the treatment for thoracolumbar kyphosis. Methods： Since December 2009 to February 2012, a total of 13 patients（8 males, 5 females） with thoracolumbar kyphosis（kyphosis cobb angle 〉60° was included in this study. 3 cases were diagnosed as failure of formation（type 1 deformity）, 6 cases as old thoracic and lumbar compression fractures, and 4 cases as old spinal tuberculosis（including one case of T3-T5 vertebral malunion）. Vertebral kyphosis located at T3-T5（n=I）, TT/8（n=l）, T8/9（n=1）, Tll/12（n=l）, T12（n=4） and Ll（n=5）. 10 cases with the lesion segments at Tll-L1 presented with serious back pain. The preoperative visual analog score （VAS） was 8.7±1.1 （8-10）. The remaining 3 kyphosis cases were associated with severe neurological deficit. The preoperative Frankel grade was C in 2 cases and D in 1 case. The average preoperative kypbosis Cobb angle was 67.3°（range, 62.0°-75.0°）. Expanded eggshell combined with closing-opening technique was used for correction. Results： The average operation time was 400±60min and the average blood loss was 960±120ml. No neurovascular injury, dural tearing, pleura1 rupture, hemothorax or pneumothorax was noted during and after operation. The average local kyphosis Cobb angle was 20.3°±2.5°（18.0°-24.5°） and the average correction rate was 68.7%. All patients received more than 2 years of follow-up, with an average of 29.6 months（range, 24-36 months）. During the follow-up, local kyphosis Cobb angle was 21.0°±3.3°（19.0°-24.2°） without sagittalimbalance. The 3 cases with neurological deficit recovered from Frankle C to D in 1 case, C to E in 1 cases, and D to E in 1 case. Loss of correction, instrument failure and fracture were not observed. Conclusions： Expanded eggshell procedure combined with closing-opening technique is a safe and effective treatment for thoracolumbar kyphosis.