经椎弓根和椎间盘截骨矫正僵硬型脊柱后凸矫形的疗效观察

Observation on efficacy of trans pedicular and trans vertebral disc osteotomy in treatment of rigid kyphosis

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。

Abstract:

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 (P<0.05).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.