改良经椎弓根截骨术治疗胸腰段陈旧性骨折伴后凸畸形

Modified pedicle wedge osteotomy for the correction of thoracolumbar old fracture with kyphosis

目的回顾性分析经后路保留椎弓根下壁的经椎弓根+椎间盘截骨术治疗胸腰段陈旧性骨折伴后凸畸形的临床疗效。方法 15例陈旧性胸腰椎骨折伴后凸畸形患者在电生理监护下经后路行保留椎弓根下壁的经椎弓根+椎间盘截骨术,患者均有严重的慢性背部疼痛,无明显的神经功能障碍。比较术前、术后3个月及末次随访时后凸Cobb角、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分。通过Suk标准观察截骨区融合情况,记录术中、术后出现的并发症。结果平均随访(15.47±7.40)个月,术后3个月Cobb角与术前比较,两者差异有统计学意义(P<0.05);末次随访时Cobb角较术后3个月无明显丢失,术后3个月及末次随访VAS评分和ODI评分,较术前均有明显改善(P<0.05),截骨融合区均达到有效融合,术中出现硬脊膜破裂1例,未出现神经损害及其他严重的并发症。结论该术式既达到了伤椎与上位椎体的骨性融合又保留了椎间孔的高度,能够安全有效地矫正胸腰椎后凸畸形、缓解患者的临床症状,并发症发生率低,是一种安全、有效的术式。

Objective To retrospectively evaluate and analyze the clinical efficacy of posterior trans-disc ＋ pedicle wedge osteotomy by preserving inferior wall of pediele in treatment of thoracolumbar old fracture with kyphosis. Methods In motor and somatosensory evoked potentials monitor, 15 patients with thoracolumbar old fracture and kyphosis were treated by posterior trans-disc ＋ pedicle wedge osteotomy with preserving inferior wall of pedicle. All of the patients had serious chronic back pain and without neurological deficit. The kyphosis Cobb angle, visual analogue scale （VAS） score, oswestry disability index （ODI） score were evaluated in preoperation, 3 months postoperation and final follow-up. The Suk standard was adopted for fusion efficacy evaluation and the complications were recorded intraoperatively and postoperatively . Results The mean follow-up was （ 15.47 ±7.40） months. The differ- ence of kyphosis Cobb angle between preoperation and 3 months postoperatively had statistical significance （ P 〈 0. 05）. The kyphosis Cobb angle at the final follow-up compared with that of 3 months postoperatively did not change. The VAS score and ODI score at 3 months after operation and final follow-up were significantly different compared with preoperative （P 〈 0.05 ）. Bone cutting surface healed osseously in all cases, and there was no neurological injury and other serious complications, and spinal dura mater tear was found in one case. Conclusion Posterior trans-disc ＋ pedicle wedge osteotomy by preserving inferior wall of pedicle is a safe and effective technique for the treatment of thoracolumbar old fracture with kyphosis.