后路脊柱截骨矫形术治疗脊柱后凸畸形的临床探讨

Posterior osteotomy in the treatment of spinal kyphosis

摘要:

目的：总结脊柱后路截骨矫形术治疗脊柱后凸畸形的治疗经验。方法：5例强直性脊柱炎患者平均后凸角度在79.0°，行L1、L3双节段楔形截骨矫形术，5例外伤性或结核性角状后凸脊柱畸形角度小于50.0°者采用单节段楔形截骨闭合矫形术，5例大于50.0°者采用单节段截骨前方垫高、后方闭合矫形术，对这些临床资料进行回顾性分析。结果：15例患者得到术后平均11个月的随访，于术后6个月均获得骨性融合。术前后凸角平均为62.3°，术后后凸角平均为15.5°，平均矫正度数为46.8°，矫正率为75.1%；术后平均身高增加4.4 cm。术前5例神经损害病例，C级1例恢复至D级，C级1例恢复至E级，D级3例恢复至E级；腰背部疼痛不适症状明显减轻。结论：弧形后凸畸形，可通过多椎体楔形截骨增加截骨度数，大角度角状后凸畸形可通过单节段截骨前方垫高、后方闭合矫形术增加矫形度数，后路楔形截骨矫形术是治疗脊柱后凸畸形的有效方法。

Abstract:

Objective：To summarize the experiences of posterior osteotomy for spinal kyphosis. Methods：Five patients with ankylosing spondylitis and an average kyphosis angle of 79.0° underwent double-segment wedge osteotomy in L1 and L3. Five patients with trau－matic or tuberculosis kyphosis and kyphosis angle less than 50.0° underwent single-segment wedge closing osteotomy. Five patients with kyphosis angle more than 50.0° underwent osteotomy with cage inserting anteriorly and closing posteriorly. Their clinical data were retrospectively analyzed. Results：Fifteen patients had an average of 11 months’ follow-up. All had bone-fusion at six months after the operation. Average kyphosis angle was 62.3° preoperatively and 15.5° postoperatively. Average correction angle and rate of kyphosis were 46.8° and 75.1% respectively. Average height was increased by 4.4 cm. For five patients with nervous injury，one pa－tient with Frankle C recovered to Frankle D；one with Frankle C to Frankle E，and three with Frankle D to Frankle E. Back pain was released obviously. Conclusions：Long round-shaped deformity can be corrected through multi-vertebral osteotomy. Severe kyphosis can be corrected through osteotomy with cage inserting anteriorly and closing posteriorly. Osteotomy correction by posterior approach is an effective method for spinal kyphosis.