经椎间孔楔形截骨术治疗创伤后胸腰椎角状后凸畸形

Transforaminal osteotomy for traumatic thoracolumbar kyphosis

目的评价经椎间孔楔形截骨术治疗创伤后胸腰椎角状后凸畸形伴脊髓损伤的临床疗效。方法回顾性分析白2006-02—2013-02采用经椎间孔楔形截骨术治疗的创伤后胸腰椎后凸畸形伴脊髓损伤32例。通过术前、术后及随访时的Cobb角、VAS评分、Frankel分级的变化评价临床疗效及后凸畸形矫正情况。结果所有患者获得随访6～72个月，平均26．2个月，后凸Cobb角术前平均45．6°，术后平均5．8°，VAS评分术前平均为8．2分，术后平均为3．1分。两者术前术后比较差异有统计学意义（P〈0．05）。神经功能Frankel分级术前C级2例，D级25例，E级5例，术后C级1例，D级21例，E级10例。所有患者术后神经功能均有不同程度的恢复。结论采用经椎间孔楔形截骨术治疗创伤后胸腰椎角状后凸畸形可获得满意的疗效。其是一种“张开-闭合”式截骨方式，具有手术操作简单、创伤小、出血少、并发症少、安全性高、神经松解减压彻底、截骨矫形效果好等优点，是治疗创伤后胸腰椎角状后凸畸形比较理想的一种手术方式。

Objective To evaluate clinical effect of transforaminal osteotomy for traumatic thoracolumbar kyphosis with spinal cord injury. Methods Thirty two patients with traumatic thoracolumbar kyphosis underwent transforaminal osteotomy from Feb. 2006 to Feb. 2013, and they were retrospectively analyzed. Cobb angle, VAS score, Frankel grade before and after operation and at the follow-up were compared to evaluate of clinical efficacy and kyphosis correction. Results All patients were followed up for 6 to 72 months, average 26.2 months. The average kyphotic Cobb angle was 45.6° preoperatively, 5.8° postoperatively. The everage VAS score was 8.2 points preoperatively, and 3.1 points postoperatively. The differences were significant （P 〈0.05）. The neural function grade of Frankel was grade C in 2 cases, grade D in 25 eases, grade E in 5 cases before operation, and after operation grade C in 1 case, grade D in 21 cases, grade E in 10 cases. The nerve function recovered in varying degrees in all patients after operation. Conclusion The transforaminal osteotomy for the treatment of traumatic thoraeolumbar kyphosis can obtain satisfactory results. Transforaminal osteotomy is an ＂open-closed＂ type osteotomy, with the advantages of simple operation, less trauma, less bleeding, fewer compheations, high safety, complete neural decompression, good osteotomy thoroughly and with good effect. It＇s a good operation mode in treatment of traumatic thoracolumbar kyphosis.