脊柱去松质骨化截骨术治疗中老年陈旧性胸腰椎骨折后凸畸形
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摘要
目的探讨脊柱去松质骨化截骨术治疗中老年陈旧性胸腰椎骨折并发后凸畸形的疗效。方法选取2016-04-2017-01收治的中老年陈旧性胸腰椎骨折并发后凸畸形患者5例,均采用脊柱去松质骨化截骨术联合椎弓根内固定治疗,观察其手术疗效。结果与术前相比,5例患者术后及末次随访的后凸Cobb角、VAS评分、ODI指数均显著改善,差异有统计学意义(P<0.01);5例患者椎体间植骨均获得骨性融合,随访期间未见内固定物断裂、松动、脱落,术后神经根损害刺激症状均消失,未见脊髓损害表现。结论脊柱去松质骨化截骨术应用于中老年陈旧性胸腰椎骨折并发后凸畸形患者,可有效恢复脊柱高度,防止矫形过度或丢失,提高植骨融合率。
Objective To explore the effectiveness of vertebral column decaneellation(VCD)for the management of chronic posttraumatic thoracolumbar kyphosis in middle and elderly. Methods From April 2016 to January 2017,5 patients with chronic posttraumatic thoracolumbar kyphosis in middle and elderly underwent VCD were reviewed. The operation techniques included singlelevel vertebral body decaneellation and residual intervertebral disc resection,followed by realignment and posterior correction with pedicle screws. The surgical curative effect was observed. Results Compared with preoperative, Cobb Angle, VAS score and ODI index of kyphoid were significantly improved in 5 patients after surgery and the last follow-up, with statistically significant differences(P<0.01). The intervertebral bone grafts of the 5 patients all obtained bone fusion. During the follow-up period, no internal fixators were broken, loosened or detached. Postoperative nerve root injury irritation symptoms disappeared, and no spinal cord injury was observed.Conclusions Single stage posterior VCD is an effective option to manage chronic posttraumatic thoracolumbar kyphosis in middle and elderly.
Objective To explore the effectiveness of vertebral column decaneellation(VCD)for the management of chronic posttraumatic thoracolumbar kyphosis in middle and elderly. Methods From April 2016 to January 2017,5 patients with chronic posttraumatic thoracolumbar kyphosis in middle and elderly underwent VCD were reviewed. The operation techniques included singlelevel vertebral body decaneellation and residual intervertebral disc resection,followed by realignment and posterior correction with pedicle screws. The surgical curative effect was observed. Results Compared with preoperative, Cobb Angle, VAS score and ODI index of kyphoid were significantly improved in 5 patients after surgery and the last follow-up, with statistically significant differences(P<0.01). The intervertebral bone grafts of the 5 patients all obtained bone fusion. During the follow-up period, no internal fixators were broken, loosened or detached. Postoperative nerve root injury irritation symptoms disappeared, and no spinal cord injury was observed.Conclusions Single stage posterior VCD is an effective option to manage chronic posttraumatic thoracolumbar kyphosis in middle and elderly.
引文
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[10]郑国权,王岩,王景明,等.后路脊柱去松质骨截骨治疗Pott’s角状后凸畸形的安全性及有效性[J].中国脊柱脊髓杂志,2016,26(1):18-23.
[2]李良晨,何登伟,梅良伟,等.胸腰椎陈旧性骨折继发后凸畸形致脊柱矢状位生理曲度改变的影像学研究[J].中华创伤杂志,2017,33(6):500-504.
[3]黄剑候,刘竞龙,孙俊凯,等.改良经椎弓根截骨矫形术治疗陈旧性胸腰椎骨折伴后凸畸形[J].中国脊柱脊髓杂志,2015,13(1):16-19.
[4] Kawahara N, TomitaK, BahaH, et al. Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach[J]. Spine(phila Pa 1976),2001,26(4):391-402.
[5]陆佳俊,吴一雄,封小光,等.经椎弓根V型截骨治疗陈旧性胸腰椎骨折后凸畸形[J].骨科,2014,5(4):198-200.
[6] Enercan M,Ozturk C, Kahraman S,et al. Osteotomies/spinal column rescetions in adult deformity[J]. Eur Spine J,2013,22 Suppl2:S254-S264.
[7]赵福江,陈志明,马华松,等.经椎弓根截骨矫形治疗僵硬型脊柱侧凸出血量的影响因素分析[J].实用骨科杂志,2018,24(2):97-100.
[8]姜超,王欢,范波,等.经椎间隙楔形截骨技术治疗脊柱侧后凸畸形[J].中华骨科杂志,2017,37(8):466-473.
[9] Zhang X, Zhang Z, Wang J, et al. Vertebral column decancellation:a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis[J]. Bone Joint J. 2016;98-B(5):672-678.
[10]郑国权,王岩,王景明,等.后路脊柱去松质骨截骨治疗Pott’s角状后凸畸形的安全性及有效性[J].中国脊柱脊髓杂志,2016,26(1):18-23.