摘要
目的探讨经椎弓根椎体楔形截骨术治疗创伤僵硬性胸腰段后凸畸形的安全性和有效性。方法解剖研究中将16具新鲜胸腰段脊柱标本按不同脊柱截骨术分为3组,A 组:脊柱开放-闭合截骨术,B 组:经椎弓根椎体楔形截骨术,C 组:改良经椎弓根椎体楔形截骨术(截骨包括上位椎问盘后半部分)。测量截骨前后 Cobb 角的变化、椎休高度和椎体前缘高度的变化。临床研究中共26例患者,其中男性18例,女性8例,平均36岁。受伤至本次手术时间3个月～11年,平均25个月。人院前治疗包括非手术治疗9例,手术治疗17例。神经损伤程度按照 Frankel 分级:A 级10例,B 级2例,C 级10例,D 级2例,E 级2例。本组病例均有不同程度的腰背部疼痛,VAS 评分平均4.5分(2.5～6.0分)。后凸角20°～75°,平均35°。根据后凸角大小选择行后路经椎弓根椎体楔形截骨术或改良椎体楔形截骨术。结果解剖研究胸腰段标本中 A 组平均纠正(38.0±2.5)°,B 组(36.0±3.6)°,C 组(49.0±2.0)°。A 组椎体高度平均增加(13.8±1.4)mm,椎体前缘增加(30.2±2.5)mm,而 B、C 组椎体高度平均短缩(2.8±0.8)mm 和(3.8±0.7)mm,前缘增加(25.0±1.2)mm 和(2.2±0.9)mm。临床研究患者均获随访,随访时间10个月～6年,平均12.5个月,患者获得满意减压和后凸畸形矫正,术后后凸角度平均为10.8°(0°～40°),脊柱后凸畸形平均矫正24°。50%患者的神经功能得到了不同程度恢复,全瘫患者恢复率为30%,主要是感觉功能恢复,而不全瘫患者的恢复率为64.3%,感觉和运动功能均有恢复。腰背部疼痛有不同程度好转,VAS 评分平均2.3分(1.0～3.5分)。结论创伤僵硬性胸腰段后凸畸形患者可以选择经椎弓根椎体楔形截骨术或改良经椎弓根椎体楔形截骨术。术后可获得满意的减压效果和后凸畸形纠正,神经功能有不同程度恢复,腰背部疼痛有不同程度好转。
Objective To investigate the safety and efficiency of spinal osteotomies for traumatic fixed kyphotic deformity of thoracolumbar spine with spinal cord injury. Methods Single-level vertebral osteotomies were performed on 3 groups of fresh-frozen human cadaveric lumbar spines. Group 1 underwent a conventional anterior opening-wedge or posterior closing-wedge osteotomy, Group 2 underwent a conventional decancellation posterior closing-wedge osteotomy, and Group 3 underwent the modified decancellation posterior closing-wedge osteotomy. Sagittal plane angulation as well as anterior height and distance of the spinal column were measured before and after osteotomy. In the clinical study, 26 cases of old thoracolumbar fractures with spinal cord injury, 36 years in average, were recruited in this study. The mean time from injury to this operation was 25 months ranging from 3 months to 11 years. Prior to the index surgery, 9 patients received conservative treatment, and 17 patients underwent surgical treatment. There were complete paraplegia in 10 cases and incomplete paraplegia in 14 cases （Frankel B 2 cases, C 10 and D 2）. The patients suffered from the low back pain, the average score of VAS was 4. 5 （2. 5 -6. 0）. The patients were found with remained kyphotic deformity of a mean 35° （20° -75°）. According to the deformity angles, conventional or modified decancellation posterior closing-wedge osteotomy was performed. Results On 3 groups of fresh-frozen human cadaveric lumbar spines, the mean correction was （38.0±2.5 ）°for Group 1, （36. 0±3.6 ） ° for Group 2, and （49. 0±2.0 ） ° for Group 3. The mean change in anterior height and distance was （ 13.8±1.4） mm and （30. 2±2. 5 ） mm respectively for Group 1. For Groups 2 and 3 it was only 2-4 mm. In clinical trial, all cases were followed up for 10 months to 6 years, average 12. 5 months. Successful decompression and satisfied correction of kyphosis was noticed. The post-operatively mean angle of kyphosis deformity was 10. 8°, ranging from 0° to 40°. Neurological functional recovery was noticed in 50% of all cases. For complete spinal cord injury, 30% of cases partially recovered （ sensory function）, whereas neurological function recovery was noted in 64. 3% of cases with incomplete spinal cord injury, a statistical difference was showed between the incomplete and complete spinal cord injury cases （ P 〈 0. 01 ）. The score of VAS was 2. 3 （ 1.0 - 3.5 ） at last follow-up. Conclusions The traumatic fixed kyphotic deformity of thoracolumbar spine with spinal cord injury could be treated with conventional or modified decancellation posterior closing-wedge osteotomy, neurological function and low back pain were expectably recovered.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第8期533-536,共4页
Chinese Journal of Surgery
