后路椎间盘松解融合固定治疗陈旧性胸腰椎骨折后凸畸形

Anterolateral disc release combined with instrumented fusion through posterior approach for old thoracolumbar fracture accompanied with kyphosis

[目的]评价经后路侧前方椎间盘切除松解治疗陈旧性胸腰椎骨折并后凸畸形的临床疗效。[方法]2014年6月~2018年12月本院脊柱外科采用经后路侧前方椎间盘切除松解治疗陈旧性胸腰椎骨折并后凸畸形患者31例,其中男19例,女12例,年龄28~68岁,平均(50.58±10.09)岁。采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和影像学测量评估临床疗效。[结果]31例患者均顺利接受手术,未出现重要血管、神经、内脏损伤等并发症。手术时间100~180 min,术中出血量180~400 ml。所有患者术后随访10~52个月。VAS评分由术前(6.87±0.92)分至末次随访降至(1.48±0.74)分,差异有统计学意义(P<0.05);ODI指数由术前(67.32±7.80)%至末次随访降至(18.35±3.67)%,差异有统计学意义(P<0.05);Cobb角由术前(38.13±3.25)°至末次随访降至(8.03±1.89)°,差异有统计学意义(P<0.05);末次随访胸腰椎正侧位X线片及CT三维重建提示椎间骨性融合良好、矫正角度保持良好,内置物位置良好,无松动、断裂等并发症。[结论]经后路侧前方椎间盘切除松解矫正陈旧性胸腰椎骨折后凸畸形临床效果满意。

[Objective]To evaluate the clinical outcomes of anterolateral disc release combined with instrumented fusion through posterior approach for treatment of old thoracolumbar fracture accompanied with kyphosis.[Methods]From June 2014 to December 2018,31 patients underwent anterolateral disc release combined with instrumented fusion through posterior approach for old thoracolumbar fractures accompanied with kyphosis.Of them,there were 19 males and 12 females,aged 28~68 years with an average age of(50.58±10.09)years.The clinical consequences were assessed by visual analogue score(VAS)for pain,Oswestry Disability Index(ODI)and imaging measurements.[Results]All the 31 patients had operations performed successfully without serious complications,such as injuries of important vessels,nerves and internal organs.The operations lasted for 100~180 minutes,associated with intraoperative blood loss of 180~400 ml.All patients were followed up from 10 to 52 months with an average of(16.97±8.49)months.The VAS scores significantly decreased from(6.87±0.92)preoperatively to(1.48±0.74)at the latest follow-up,additionally the ODI significantly decreased from(67.32±7.80)%preoperatively to(18.35±3.67)%at the final follow-up,which all were statistically significant(P<0.05).In term of radiographic evaluation,the Cobb angle significantly decreased from(38.13±3.25)°preoperatively(8.03±1.89)°to the latest follow-up,with a significant difference(P<0.05).To the latest follow-up,the images,including X-rays on anteroposterior and lateral views,three-dimensional CT of the thoracolumbar spine showed good intervertebral bony fusion in properly corrected position without obvious loosening or breaking of the implants.[Conclusion]This anterolateral disc release combined with instrumented fusion through posterior approach does achieve satisfactory clinical outcomes for old thoracolumbar fracture accompanied with kyphosis.