【摘要】 目的探讨后路顶椎楔形截骨术治疗陈旧性胸腰椎骨折所致脊柱后凸畸形的方法及治疗效果。方法28例陈旧性胸腰椎骨折后凸畸形患者,伴骨髓损伤者21例,平均伤后32个月,均行顶椎楔形截骨、椎弓根内固定系统固定术,比较手术前后结果。术后随访13~28月,平均16.2月。结果所有患者手术后胸腰椎生理弧度良好,后凸Cobb’s角由术前30.3°±3.3°恢复为手术后的7.2°±4.0°(P<0.05),平均矫正角度为27.2°±7.4°,随访无角度丢失;15例CT复查显示手术减压满意;21例术前伴脊髓损伤者手术后Frankel恢复一级以上者为18例(85.7%);所有患者腰背部疼痛均明显减轻。结论顶椎楔形截骨术是治疗陈旧性胸腰椎骨折所致后凸畸形的一种有效方法,具有畸形矫正满意、入路简单、显露充分、脊髓前后方均可有效减压、手术后伤椎稳定且并发症少等特点。更多还原

【Abstract】 Objective To assess the effectiveness of wedge-shape osteotomy at the deformed vertebrae to correct kyphosis,which due to old thoracolumbar vertebral fracture.Methods All 28 patients received old thoracolumbar vertebral fracture,21 with spinal cord injury.At an average period of 32 months after injury,they were treated with wedge osteotomy at the level of apical vertebrae for correction and with pedicle screw instrumentation for fixation through a posterior-only approach.Mean follow-up was 16.2 months(range,13~28 months).Every case was analyzed for operative effect and follow-up results.Results The precorrection kyphosis ranged from 19~41°,with a mean of 30.3°±3.3°.After correction,kyphosis was reduced to an average of 11.2°±4.0°,with a range from-2°~14.3°.The average angle of correction was 27.2° ± 7.4°.Significant difference was found between pre-and post-operative kyphosis measures(P<0.05).No major complication occurred in any patient.The low back pain and neurological deficits were improved and excellent bone fusion was achieved.The Frankel grade of 85.7%(18/21) of all patients with spinal cord injure improved one or more degrees after operation.No patient had any notable loss of correction between discharge and final follow-up.Conclusion Wedge-shape osteotomy at the deformed vertebrae is an effective method for the correction of kyphosis which due to old thoracolumbar vertebral fracture.It is suitable for the treatment of incomplete paraplegia patients with both anterior and posterior compression.This method is not only a simple approach,better stability after operation,but local kyphosis is corrected satisfactorily.更多还原