一期后路椎间隙松解+Ponte截骨治疗胸腰段脊柱陈旧性骨折并后凸畸形

Clinical effectiveness of posterior intervertebral space release combined with Ponte osteotomy in treating old thoracolumbar fracture complicated with kyphotic deformity without neurological symptoms

目的评价一期后路椎间隙松解+Ponte截骨矫形治疗无神经症状胸腰段脊柱陈旧性骨折并后凸畸形的临床疗效。方法回顾性分析2009年1月至2013年1月我院采用后路椎间隙松解+Ponte截骨矫形治疗无神经症状胸腰段脊柱陈旧性骨折并后凸畸形病人15例,其中男10例,女5例;年龄为38~52岁,平均为44.3岁。采用疼痛视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数问卷表(Oswestry disability index,ODI)评价临床症状的改善情况,测量X线侧位片脊柱后凸畸形Cobb角评价后凸畸形的纠正情况,通过CT检查了解植骨融合情况。结果病人均获得随访,随访时间为12~39个月,平均为18.1个月。脊柱后凸畸形Cobb角术前平均为43.1°±9.0°,术后平均为8.1°±3.0°;VAS评分术前平均为(6.5±1.4)分,术后平均为(2.5±0.8)分;ODI评分术前平均为(37.8±6.1)分,术后平均为(6.7±2.5)分。3个指标术后与术前比较,差异均有统计学意义(均P<0.05)。无血管、神经损伤等严重并发症发生。以上3例病人出现肋间神经麻痹症状,3个月后症状消失。1例出现胸腔积液,经闭式引流治愈。1例植骨愈合欠佳,但是无矫正度丢失和内固定断裂表现;余病例植骨愈合良好。结论一期后路椎间隙松解+Ponte截骨矫形治疗无神经症状胸腰段脊柱陈旧性骨折并后凸畸形可获得较为满意的临床效果,是治疗此类疾病可供选择的手术方式。

Objectives To evaluate the clinical effectiveness of posterior intervertebral space releasecombined with Ponte osteotomy in treating old thoracolumbar fracture complicated with kyphotic deformitywithout neurological symptoms. Methods Fifteen patients suffering from old thoracolumbar fracturecomplicated with kyphotic deformity were treated with posterior intervertebral space release combined withPonte osteotomy from January 2009 to January 2013, and the clinical effectiveness was retrospectively analyzed.Among the 15 cases, there were 10 male patients and 5 female patients, with the age ranging from 38 to 52 yearsold(average 44.3). Visual analogue scale(VAS) and Oswestry disability index(ODI) were employed to evaluatethe improvement in clinical symptoms. The Cobb angle on the lateral X-ray was determined to evaluate theeffect of kyphotic deformity correction. The status of bone graft fusion was judged with CT scan. Results Thepatients were followed up for 12-39 months, with the average of 18.1 months. The pre-operative and post-operative Cobb angles were 43.1°±9°and 8.1°±3°, respectively. The pre-operative and post-operative averageVAS scores were 6.5±1.4 and 2.5±0.8, respectively. The pre-operative and post-operative average ODI scoreswere 37.8 ± 6.1 and 6.7 ± 2.5, respectively. All the comparison parameters showed statistically significantdifferences(P<0.05). There were no any neurovascular(nerve and vessels) injuries. But the 3 cases presentedwith paralysis of intercostal nerve, and the symptom disappeared after 3 months. There was 1 case of pleuraleffusion, which was relieved by closed drainage. During the follow-up period one case had poor bone grafthealing, and there was no loss of correction or failure of internal fixation. In the rest 14 cases, the bone graft waswell healed. Conclusion Satisfactory decompression and correction effects were obtained in the treatment ofold thoracolumbar fracture complicated with kyphotic deformity by one-stage posterior intervertebral spacerelease and Ponte osteotomy. This method has minimal complications, and it is an optional technique forthoracolumbar kyphotic deformity.