扩大“蛋壳”结合闭合-张开技术治疗胸腰椎角状后凸畸形

Expanded eggshell and closing-opening procedure of the treatment for thoracolumbar angular kyphosis

中文关键词:  脊柱后凸畸形  蛋壳技术  闭合-张开技术  疗效

英文关键词:Kyphosis  Eggshell  Closing-opening procedure  Efficacy

中文摘要:

  【摘要】 目的：总结扩大“蛋壳”结合闭合-张开技术治疗胸腰椎角状后凸畸形的手术疗效。方法：2009年12月~2012年2月采用扩大“蛋壳”结合闭合-张开技术治疗13例胸椎及胸腰段角状后凸畸形患者，男8例，女5例；年龄15~47岁，平均33.5岁；完全分节后方半脊椎畸形3例，陈旧性胸椎及腰椎骨折后凸畸形6例，陈旧性脊柱结核后凸畸形4例（其中1例为T3~T5畸形愈合）。后凸顶椎部位：T3~T5 1例，T7/8 1例，T8/9 1例，T11/12 1例，T12 4例，L1 5例。10例病变节段位于T11~L1水平者均存在严重腰背部疼痛，VAS评分8~10分，平均8.7±1.1分；3例胸段后凸畸形者均合并神经功能障碍，Frankel C级 2例，D级1例。术前局部后凸角度62.0°~75.0°，平均67.3°。采用扩大“蛋壳”结合闭合-张开技术矫正后凸畸形，观察术后症状改善及畸形矫正情况。结果：患者均顺利完成手术，手术时间400±60min，术中失血为960±120ml。术中无节段血管、神经损伤，无硬膜撕裂、胸膜破裂和/或血气胸等并发症。术后局部后凸角矫正至18.0°~24.5°，平均20.3°±2.5°，平均矫正率为68.7%。所有患者术后均获得随访，随访时间24～36个月，平均29.6个月，末次随访时后凸角为19.0°~24.2°，平均21.0°±3.3°，与术后比较无显著性差异（P>0.05）；无矢状面失平衡者。术前胸背部疼痛患者VAS评分改善至2.1±1.9分，与术前比较有显著性差异（P<0.05）。术前2例Frankel C级患者1例恢复至D级、1例恢复至E级，1例D级患者恢复至E级。随访期间无内固定器械松动、断裂等并发症，植骨均融合。结论：扩大“蛋壳”结合闭合-张开技术治疗胸腰椎角状后凸畸形手术相对安全，矫正率较高，疗效可靠。

英文摘要:

  【Abstract】 Objectives: To determine the efficacy of combined expanded eggshell and closing-opening procedure of the treatment for thoracolumbar kyphosis. Methods: Since December 2009 to February 2012, a total of 13 patients(8 males, 5 females) with thoracolumbar kyphosis(kyphosis cobb angle >60° was included in this study. 3 cases were diagnosed as failure of formation(type 1 deformity), 6 cases as old thoracic and lumbar compression fractures, and 4 cases as old spinal tuberculosis(including one case of T3-T5 vertebral malunion). Vertebral kyphosis located at T3-T5(n=1), T7/8(n=1), T8/9(n=1), T11/12(n=1), T12(n=4) and L1(n=5). 10 cases with the lesion segments at T11-L1 presented with serious back pain. The preoperative visual analog score(VAS) was 8.7±1.1(8-10). The remaining 3 kyphosis cases were associated with severe neurological deficit. The preoperative Frankel grade was C in 2 cases and D in 1 case. The average preoperative kyphosis Cobb angle was 67.3°(range, 62.0°-75.0°). Expanded eggshell combined with closing-opening technique was used for correction. Results: The average operation time was 400±60min and the average blood loss was 960±120ml. No neurovascular injury, dural tearing, pleural rupture, hemothorax or pneumothorax was noted during and after operation. The average local kyphosis Cobb angle was 20.3°±2.5°(18.0°-24.5°) and the average correction rate was 68.7%. All patients received more than 2 years of follow-up, with an average of 29.6 months(range, 24-36 months). During the follow-up, local kyphosis Cobb angle was 21.0° ±3.3°(19.0°-24.2°) without sagittal imbalance. The 3 cases with neurological deficit recovered from Frankle C to D in 1 case, C to E in 1 cases, and D to E in 1 case. Loss of correction, instrument failure and fracture were not observed. Conclusions: Expanded eggshell procedure combined with closing-opening technique is a safe and effective treatment for thoracolumbar kyphosis.