摘要
目的分析胸腰椎骨折术后迟发性后凸畸形的临床特征，探讨后路截骨矫形的术式选择并总结疗效。方法胸腰椎骨折术后迟发性后凸畸形患者27例，男22例，女5例；年龄24-52岁，平均34岁：后凸畸形Cobb角36°-720°，平均48°。10例采用后路经关节突“V”型截骨术，17例采用后路经椎弓根椎体截骨脊柱缩短术。结果胸腰椎骨折术后迟发性后凸畸形危险因素为初次后路手术未行植骨融合、初次手术未满意恢复骨折椎体的高度及固定节段过度撑开。经关节突“V”型截骨术后矢状面的纠正平均为24°（14°-43°），经椎弓根椎体截骨术后矢状面的纠正平均为40°（17°-44°）；末次随访时经关节突“V”型截骨平均矫正丢失5°，经椎弓根椎体截骨平均矫正丢失3°；26例（96．2％）实现骨性融合，经关节突“V”型截骨术出现1例假关节（3．8％）。结论 胸腰椎骨折术后迟发性后凸畸形的临床特征为疼痛、畸形、力学不稳定或神经损害，可以根据畸形僵硬的程度选择不同的后路截骨方式。经椎弓根椎体截骨脊柱缩短术经单一人路就可达到缩短脊柱、纠正畸形、脊髓减压及植骨融合内固定，具有后凸纠正率高、残留畸形小、矫正丢失少及融合率高的优越性，但其技术要求较高、潜在的神经并发症亦不容忽视。
Objective To analyze clinical characteristics of late kyphosis in thoracolumbar fracture and discuss the osteotomy indication and outcome for posterior correction. Methods A retrospective study was made in 27 cases with late kyphosis secondary to thoracolumbar fracture. There were 22 males and 5 females aged from 24 to 52 years with the mean age of 34 years. Pre-operative kyphosis ranged from 32° to 72° （mean 46°）. Trans-articular V shape osteotomy was performed in 10 cases, seventeen patients were treated with transpedicular vertebral osteotomy with spinal shortening. Results The major risk factors causing late kyphosis were as following： no posterior fusion, no satisfied restoration of vertebral body height, and overdistraction of fixation segment. Immediate sagittal correction averaged 24° （ranged 14°-43°） in patients treated with V shape osteotomy, and that for transpedicular vertebral osteotomy averaged 40°（ranged 17°- 44°）. At the last follow-up, the average loss of correction was 5° for trans-articular V shape osteotomy, and that for transpedicular vertebral osteotomy was 3°. Solid fusion was achieved in 26 cases, one patient treated with V shape osteotomy had pseudoarthrosis. Conclusion The clinical characteristics of late kyphosis are pain, deformity, mechanical instability and sometimes neurological deficit. These two osteotomy techniques may be chosen according to the rigidity of sagittal deformity. Transpedicular vertebral osteotomy through one approach can achieve spinal shortening, kyphosis correction, spinal cord decompression and internal fixation with fusion. Vertebral shortening using a posterior approach has the advantages of high correction rate, less residual kyphosis,less loss of correction and high fusion rate, however, it requires high demanding tech- niques and its potential neurological complication should be kept in mind.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2008年第3期187-191,共5页
Chinese Journal of Orthopaedics
关键词
脊柱后凸
胸椎
腰椎
骨折
截骨术
kyphosis
Thoracic vertebrae
Lumbar vertebrae
Fractures
Osteotomy
