摘要
目的探讨导航辅助下经椎弓根截骨治疗陈旧性胸腰椎骨折伴后凸畸形的手术疗效及安全性。方法回顾性分析2003年2月～2006年4月采用计算机导航辅助经椎弓根截骨治疗的46例陈旧性脊柱骨折伴后凸畸形患者资料，其中男32例，女14例；平均年龄为（39．71±11．92）岁。胸椎（T1～T12）骨折20例，腰椎（L4～L4）骨折26例。伤后至手术时间平均为（3．67±2．94）年。结果45例患者术后获平均（11．82±7．64）个月（3～34个月）随访，按照Odom标准：优27例，良16例，可2例，优良率为95．6％。后凸Cobb角术前为37．19°±20．17°，术后为12．56°±15．44°，随访时为13．81°±15．07°，术前与术后比较差异有统计学意义（t=7．80，P〈0．01），术后与随访时比较差异无统计学意义（t=-1．03，P=0．319）。无一例发生血管及神经损伤等并发症。结论导航辅助下经椎弓根闭合楔形截骨是一种治疗陈旧性脊柱骨折伴后凸畸形有效而安全的方法。术中在计算机导航辅助下，可以准确置钉、实时了解截骨精确位置，避免神经血管损伤，增加手术安全性，减少手术并发症。
Objective To evaluate the outcome and safety of computer guided transpedicular wedge osteotomy for treatment of thoracolumbar old fracture plus kyphosis. Methods From February 2003 to April 2006, 46 patients （32 males, 14 females, with an average age of 39.71±11.92） underwent computer-guided transpedicular wedge osteotomy for their thoracolumbar old fracture and kyphosis. Twenty patients suffered thoracic fractures （T1-T12） and 26 patients lumbar fracture （L1-L4） . The average interval from injury to operation was 3.67±2.94 years. CT guidance was applied for 29 cases and X-ray guidance for 17 cases. Results The average follow-up time was 11.82±7.64 months. According to Odom＇s criteria, 27 were rated as excellent, 16 good, 2 fair and 0 poor. The good to excellent rate was 95.6%. The Cobb angle of kyphosis decreased significantly after operation （37. 19°±20. 17° vs. 12.56°±15.44°, P 〈0.01）, while there was no significant difference between the post-operative Cobb angle and that at the follow-up （12.56°±15.44° vs. 13.81°±15.07°, P 〉 0. 05） No complication occurred. Conclusions Computer-guided transpedicular wedge osteotomy is a safe and effective treatment for the thoracolumbar old fracture plus kyphosis. Under intraoperative navigation, it is possible to insert the pedicle screw accurately, to trace the real-time wedge osteotomy, to avoid nervous and vascular injuries and to reduce the loss of correction of kyphosis. Navigation can also increase the safety of operation and reduce the incidence of complication.
出处
《中华创伤骨科杂志》
CAS
CSCD
2007年第7期616-618,共3页
Chinese Journal of Orthopaedic Trauma
关键词
外科手术
计算机辅助
截骨术
畸形
脊柱骨折
Surgery, computer-assisted
Osteotomy
Abnormalities
Spinal fracture
