经椎弓根截骨术治疗胸腰段创伤性后凸畸形

Transpedicular osteotomy for treatment of thoracolumbar kyphosis deformity

目的评价经椎弓根截骨术治疗胸腰段创伤性后凸畸形的临床疗效。方法采用经椎弓根截骨术治疗23例胸腰段创伤性后凸畸形患者。观察手术前后VAS评分、胸腰段后凸Cobb角及JOA评分。结果手术时间155~240(183±17)min,术中出血量1 000~3 000(1 487±430)ml。术中1例硬膜破裂,2例出现短暂不全瘫。术后无感染病例。患者均获得随访,时间21~60个月。术后1个月及术后1年的VAS评分、Cobb角、JOA下腰痛评分均较术前改善,差异均有统计学意义(P<0.05)。术后1年截骨界面均达骨性融合。末次随访X线片显示无内固定断裂、松动等并发症。结论后路经椎弓根截骨术治疗胸腰段创伤性后凸畸形矫正效果满意。

Objective To investigate the therapeutic effect of transpedicular osteotomy for treatment of thoracolumbar kyphosis deformity caused by fracture. Methods The 23 cases of thoracolumbar kyphosis deformity were treated with transpedicular osteotomy. The radiographs were taken pre-and postoperatively to evaluate visual analogue scale（ VAS）,rectification of thoraolumbar Cobb angle and JOA score. Results The operation time was 155 - 240（ 183 ± 17） min,and the bleeding volume was 1 000 - 3 000（ 1 487 ± 430） ml. There was 1 case of dural tear,2 cases of transient paresis,no infected patients were found. All patients were followed up for 21 - 60 months,VAS,Cobb angle and JOA score of follow-up patients for 1 month and 1 year after operation were significantly improved,compared with the preoperation,differences were statistically significant（ P〈0. 05）. The bone fusion was achieved at1 year postoperation,no fracture or looseness of internal fixation happened. Conclusions The treatment for thoracolumbar kyphosis deformity caused by fracture can obtain satisfactory the orthopedic effect and curative effect by transpedicular osteotomy.