摘要
目的:评价经椎弓根+椎间盘截骨术矫治脊柱后凸畸形的效果,并探讨其适应证。方法:对25例脊柱后凸畸形行经椎弓根+椎间盘截骨术治疗。其中男15例,女10例;年龄平均48.6岁(8～69岁)。其中陈旧创伤性后凸19例、先天性后凸6例。术前后凸Cobb角(40.56±11.05)°。脊髓损伤程度按Frankel分型:C级1例,D级1例,E级23例。25例中均有腰背部疼痛不适、平卧困难。其中2例伴有膀胱括约肌功能障碍,4例先天性后凸还表现为后凸进行性加重。结果:所有患者均顺利完成手术,手术时间3.0～6.0 h,平均4.5 h;术中出血量800～2 500 ml,平均1 550 ml。术后患者切口均Ⅰ期愈合,无深部感染、呼吸衰竭或深静脉血栓形成等并发症发生。25例均获随访,随访时间12～28个月,平均18个月。未发现内固定物松动断裂、假关节形成等并发症。腰痛均缓解,神经功能Frankel C级1例恢复到D级,2例膀胱括约肌功能障碍者中术后症状有改善。术后1周及末次随访时后凸Cobb角与术前比较均有明显改善,差异有统计学意义(P<0.05)。与术后1周相比,末次随访时获得矫形均无丢失。结论:经椎弓根椎体+椎间盘截骨术治疗脊柱后凸畸形可安全实施,矫正效果良好。
Objective：To evaluate the efficacy of trans-pedicular and trans-vertebral disc osteotomy in the treatment of kyphosis and to discuss its indications.Methods：Twenty-five patients with kyphosis deformity were surgically treated with trans-pedicular and trans-vertebral disc osteotomy including 15 males and 10 females with the average age of 48.6 years old（from 8 to 69 years old）.There were 19 cases of post-traumatic kyphosis and 6 cases of congenital kyphosis with scoliosis.The preoperative mean kyphotic Cobb angle was（40.56±11.05）°.According to the Frankel grading system,1 case was classified as grade C,1 case as grade D and 23 cases as grade E preoperatively.All the patients had severe thoracolumbar dorsum pain with difficulty of lying flat.There were 2 cases complicated with bladder sphincter dysfunction and 4 cases of congenital kyphosis underwent progressive deformities.Results：All surgeries were finished successfully.The operation time was 3.0~6.0 h（averaged 4.5 h） and the perioperative bleeding was 800~2 500 ml（averaged 1 550 ml）.All incisions were healed by the first intention with no infection or deep venous thrombosis being observed.All cases were followed up from 12~28 months（averaged 18 months）.No pseudoarthrosis and implant failure were occurred.Preoperative back pain was allievated in all cases.Neurologic improvement was occurred in 1 case from Frankel grade C to grade D after the surgery.The bladder sphincter function were also improved in 2 cases postoperatively.The Cobb angles of kyphosis at one week after the operation and the last follow-up were obviously improved when compared with the preoperative ones,showing significant differences（P0.05）.No obvious correction loss was observed either in coronal or sagittal plane.Conclusion：Trans-pedicular and trans-vertebral disc osteotomy is an effective and safe surgical technique for kyphosis.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2012年第5期457-460,共4页
Journal of Chongqing Medical University
关键词
脊柱后凸
僵硬型
截骨术
矫形
kyphosis
rigid
osteotomy
corrective surgery
