三柱截骨术治疗脊柱后凸并脊髓或神经根压迫症

Treatment of kyphosis with compression of spinal cord or nerve root by spinal three-column osteoto-my

目的:探讨脊柱后凸畸形合并脊髓或神经根压迫症的手术治疗方法。方法:采用脊柱前、中、后三柱截骨的方法,治疗脊柱后凸并脊髓压迫症17例,脊髓功能按Frankel分级,A级2例,C级3例,D级5例,E级7例;神经根压迫症5例。术中解除压迫脊髓或神经根的致压因素,同时进行矫形、内固定及植骨融合。结果:22例均获得有效减压,后凸角矫正率平均57.8%。术后脊髓功能2例A级(Frankel分级)无恢复,3例C级恢复至D级2例、恢复至E级1例,5例D级均恢复至E级,5例神经根压迫症患者症状和体征明显改善。术后4～6个月截骨间隙达到骨性融合。结论:脊柱三柱截骨手术可以同期行脊髓或神经根减压、减张、脊柱矫形和截骨间隙植骨融合以重建脊柱的稳定性,是治疗脊柱后凸并脊髓或神经根压迫症较好的方法。

Objective:To evaluate the operative method about kyphosis with compression of spinal cord or nerve root.Method:17cases kyphosis with compression of spinal cord and5cases with nerve root entrapment syndrome were treated with Wedge-shaped spinal three column osteotomy,and internal fixation,bone graft.Re-sult:22cases obtained significance decompression and spinal correction.The average correction of kyphosic was57.82%.Spinal cord and nerve root decompressed.Function of spinal cord were A grade:2cases,D grade:2cases,E grade:13cases,5cases with nerve root entrapment syndrome recovered to the normal.There were bone fusion at4～6months postoperation.Conclusion:Wedge-shaped spinal three column osteotomy is an effective procedure for patients of kyphosis with compression of spinal cord or nerve root.Only one time operation is needed for decompression,spinal correction,auto-bone geaft,so the spinal stability can be reconstructed.