有限截骨固定治疗陈旧性胸腰椎骨折并后凸畸形

Limited osteotomy and discectomy combined with pedicle screw fixation for old thoracolumbar fracture accompanied with kyphosis

[目的]探讨有限截骨矫形椎弓根固定陈旧性胸腰椎骨折后凸畸形的临床效果.[方法]回顾性分析2010年7月-2015年12月,两所医院采用有限截骨固定治疗单节段陈旧性胸腰椎骨折并后凸畸形120例患者的临床资料.总结临床与影像资料.[结果]120例患者均顺利完成手术,均无严重并发症.随访12个月以上.其中,术前有神经损害症状的患者,术后神经功能均有所恢复.随时间推移,患者VAS评分显著下降(P<0.05),而JOA评分显著增加(P<0.05).影像方面,与术前相比,术后6个月伤椎局部后凸Cobb角均显著减小(P<0.05);与术后6个月相比,末次随访时后凸Cobb角无显著变化(P>0.05).所有患者均达到截骨-椎间隙骨性融合.[结论]有限截骨固定治疗陈旧性胸腰椎骨折能够有效缓解临床症状,取得良好的临床效果.

[Objective]To explore the clinical outcomes of limited osteotomy and discectomy combined with pedicle screw fixation for old thoracolumbar fracture in a single level accompanied with kyphosis.[Methods]A retrospective study was conducted on a total of 120 patients who underwent abovesaid surgical procedures for a single-level old thoracolumbar fracture complicated with kyphosis in two hospitals from July 2010 to December 2015.The documents regarding to clinical settings and radiographic examinations were summarized.[Results]All 120 patients were operated on successfully without serious complications,and followed up for more than 12 months.Among them,the patients with symptoms of nerve damage preoperatively had better recovery of nerve function after surgery.The VAS scores decreased significantly(P<0.05),while JOA score increased significantly over time(P<0.05).Radiographically,the Cobb Angle of the local kyphosis of the injured vertebrae was significantly reduced 6 months after surgery compared with that before surgery(P<0.05),while there was no significant change in kyphosis Cobb angle at the last follow-up compared to 6 months postoperatively(P>0.05).All patients got solid bony fusion of the involved intervertebral space with osteotomy.[Conclusion]The limited osteotomy and discectomy combined with pedicle screw fixation do effectively relieve the clinical symptoms,get sound clinical outcomes for a single-level old thoracolumbar fracture accompanied with kyphosis.