摘要
目的探讨一期后路全脊椎切除(PVCR)治疗胸腰段结核继发僵硬性角状后凸畸形的安全性和有效性。方法 2004年1月至2009年9月,12例胸腰段结核继发僵硬性角状后凸畸形患者接受手术,男4例、女8例,平均年龄42.4岁。术前及术后3、6、12个月,之后每隔1年分别测量脊柱后凸Cobb角,并行神经功能Frankel分级、疼痛视觉模拟评分(visual analogue scale,VAS)。结果手术时间平均5.5h,术中出血平均2410ml;无围手术期死亡病例发生。平均随访25.3个月,术前、术后测得后凸Cobb角分别为49.9°±12.5°、18.3°±3.4°,平均矫正31.7°±10.9°,矫正率为62.8%±5.8%。术前合并神经功能障碍5例,FrankelC级3例、D级2例,术后FrankelD级1例,神经功能改善率80%。围手术期发生脑脊液漏和切口感染各1例,发生率为16.7%;随访期发现内固定物松动1例,发生率为8.3%。术前VAS评分平均7.8分,术后平均2.9分,改善率62.3%。所有病例均未出现神经损伤并发症,植骨节段全部骨性融合。结论一期PVCR可安全有效地用于胸腰段结核病灶清除、矫正僵硬性角状后凸畸形。
Objective To evaluate the safety and efficacy of posterior vertebral column resection（PVCR） in treatment of rigid and severe kyphotic deformities in thoracolumbar spine.Methods From January 2004 to September 2009,12 patients（4 males,8 females） with a mean age of 42.4 years old with severe post-tubercular kyphotic deformities who underwent posterior vertebral resection were retrospectively reviewed.All patients were evaluated before and 3rd,6th,12th month postoperatively,then once a year.Radiologic assessment including the angle of kyphosis and neurologic status by modified Frankel grade and visual analogue scale（VAS） were analyzed.Results The mean operation time was 5.5 h,the average intraoperative blood loss was 2410 ml.The follow-up averaged 25.3 months and no perioperative mortality occurred.The preoperative kyphosis was 49.9°±12.5° and in the immediate postoperative period was 18.3°±3.4° with an average postoperative kyphosis correction of 31.7°±10.9° and correction rate of 62.8%±5.8%.Five cases with preoperative neurological dysfunction,Frankel＇s grade C in 3 patients and grade D in 2 patients,but only one case in grade D postoperative showed 80% neurologic improvement.Perioperative complications occurred respectively in 2（16.7%） of the 12 patients including cerebrospinal fluids leakage and superficial infections.Looseness of fixation in one case（8.3%） was found postoperation.The mean VAS was 7.8 and 2.9 in pre-and post-operation showed 62.3% improvement in back pain relief.Fusion of the resection site was confirmed on radiographs in all patients and no neural injury was found during follow-up.Conclusion A single-stage posterior-only vertebral resection is an effective and safe way to treat post-tubercular kyphotic deformities for the thoracolumbar spine.
出处
《中国骨与关节外科》
2011年第6期434-440,共7页
Chinese Journal of Bone and Joint Surgery
关键词
脊柱结核
结核后凸畸形
后路全脊椎切除
截骨术
Tuberculosis
Spinal
Post-tubercular kyphosis
Posterior vertebral column resection
Osteotomy
