一期后前路联合松解矫形治疗胸腰椎陈旧骨折伴后凸畸形

One stage posterior-anterior correction for thoracolumbar kyphosis due to chronic spine fracture

中文关键词:  胸腰椎骨折  陈旧性  后凸畸形  矫形  前后路

英文关键词:Thracolumbar fracture  Chronic  Kyphosis  Correction  Anterior-posterior approach

中文摘要:

  【摘要】　目的：探讨一期后前路联合松解矫形治疗胸腰椎陈旧骨折伴后凸畸形的临床疗效。方法：2005年6月～2010年10月收治21例胸腰椎陈旧骨折伴后凸畸形患者，男13例，女8例，年龄23～61岁，平均37．6岁。均为单节段骨折，角状后凸顶点：T11 1例，T12 7例，L1 8例，L2 5例；后凸Cobb角23°～59°，平均38.6°。均有严重腰背痛症状，术前VAS评分为7.1～10（7.6±2.1）分。9例伴有神经功能障碍，术前Frankel分级：B级2例，C级2例，D级5例；其中4例合并括约肌功能障碍。2例曾行单纯椎板减压手术，10例曾行椎板减压内固定术。术前CT显示关节突骨性融合14例，骨折椎体前方有骨赘及骨桥形成16例。均采用一期后前路联合松解、减压、前路椎体间植骨、内固定术治疗。随访观察患者临床症状及影像学改善情况。结果：手术均顺利完成，手术时间150~310min，平均200min；术中失血量400~1200ml，平均650ml。术中、术后无一例出现严重并发症。患者均获随访，随访时间12～60个月，平均21.3个月，腰背痛症状均明显缓解，VAS评分改善至1.5～2.6（2.1±0.4）分；后凸角明显改善，末次随访时后凸Cobb角为5°～23°（11.1°±5.8°），与术前比较差异有统计学意义（P<0.05），平均矫正率为71.3%。植骨节段均骨性融合，融合时间平均4.3个月。9例有神经功能障碍者术后8例有不同程度恢复，4例括约肌功能障碍者3例改善。结论：一期后前路联合松解、减压、矫形治疗胸腰椎陈旧骨折伴后凸畸形手术安全，能早期重建脊柱稳定性，效果满意。

英文摘要:

  【Abstract】　Objectives: To evaluate the feasibility of one stage posterior-anterior correction for thoracolumbar kyphosis due to chronic spine fracture. Methods:　Between June 2005 and October 2010,　21 cases suffering from thoracolumbar kyphosis due to chronic spine fracture were treated surgically.　There were 13 males and 8 females with an average age of 37.6 years(range, 23-61 years). All cases had single segmental fractures, with the affected levels of T11 in 1 case,　T12 in 7 cases,　L1 in 8 cases, and L2 in 5 cases.　The kyphotic Cobb angle averaged 38.6°(range,　23°-59°). All the patients presented serious low back pain. The preoperative VAS score of back pain averaged 7.6(range, 7.1-10). 9 cases were complicated with neurological deficits. According to preoperative Frankel grading system, there were 2 grade B,　2 grade C and 5 grade D. Four patients were complicated with sphincter dysfunction. The preoperative CT showed osseous fusion of articular process joint in 14 cases, osteophyte and bone bridge formation in 16 cases.　The kyphotic Cobb angle,　neural function and VAS of back pain were reviewed and compared. Results:　All patients underwent surgery safely and no severe complications were noted. The operation time was 150-310min(average, 200min), and the perioperative blood loss was 400-1200ml(average, 650ml).　All cases were followed up for 12-60 months(average, 21.3 months). Postoperative low back pain alleviated in all cases, with the VAS score averaging 2.1（range, 1.5-2.6） at 1 year after operation.　The Cobb angle of kyphosis averaged 11.1°(range, 5°-23°) at final follow-up, which improved significantly compared with the preoperative ones(P<0.05). The correction rate was 71.3%. Solid fusion was obtained with the fusion duration of 4.3 months in average.　Eight patients had neurofunction improved, while sphincter function improved in 3 cases. Conclusions: One stage posterior-anterior release and correction is effective and reliable for thoracolumbar kyphosis due to chronic spine fracture.