后路截骨矫形长节段固定治疗老年性胸腰段后凸畸形

目的:探讨后路截骨矫形长节段固定治疗老年性胸腰段后凸畸形的疗效,为老年性胸腰段后凸畸形的外科治疗提供参考。方法:对2007年4月至2010年4月手术治疗的19例老年性胸腰段后凸畸形的临床资料进行回顾性分析,男12例,女7例;年龄58～74岁,平均62岁;陈旧性骨折11例,强直性脊柱炎3例,脊柱陈旧结核5例。术前神经功能Frankel分级:E级12例,D级4例,C级2例,B级1例。19例患者均采用后路经顶椎截骨矫形长节段内固定术,均进行至少1年以上随访。分析内容包括术前、术后2周及术后1年患者疼痛VAS评分,后凸Cobb角,神经功能和术后并发症。结果:19例患者术前、术后2周、术后1年VAS评分分别为(7.0±1.2)、(1.1±0.7)、(1.3±0.8)分,后凸Cobb角分别为(44.1±6.9)、(10.9±3.1)、(11.5±2.8)°;VAS评分和后凸Cobb角术前与术后2周比较,差异均有统计学意义(P<0.05),术后2周与术后1年比较,差异均无统计学意义(P>0.05)。末次随访时18例(94.7%)符合骨性融合的标准,1例于术后1年截骨面未完全融合,但未出现内固定松动现象。神经症状:D级4例中有3例恢复至E级;C级的2例恢复至D级;B级1例恢复至C级。结论:后路截骨矫形长节段固定术治疗老年胸腰段后凸畸形,可取得良好的近期疗效。

Posterior osteotomy and long-segment internal fixation for the treatment of senile thoracolumbar kyphotic deformity

Objective:To explore the therapeutic effects of posterior osteotomy and long-segment internal fixation in the treatment of senile thoracolumbar kyphotic deformity and provide the reference for operative treatment. Methods:From April 2007 to April 2010,19 older patients with thoracolumbar kyphotic deformity were respectively analyzed. There were 12 males and 7 females with an average age of 62 years(ranged,58 to 74 years). Among patients,11 cases were old fracture,3 cases were ankylosing spondylitis,and 5 cases were old spinal tuberculosis. According to preoperative Frankel classification,12 cases were grade E,4 cases were grade D,2 cases were C and 1 case was grade B. All patients were treated by posterior osteotomy and long-segment internal fixation and followed up above 1 year. VAS score preoperative,2 weeks and 1 year after operation,Cobb's angle,nerve function and complication were observed. Results:VAS score preoperative,2 weeks and 1 year after operation separately was(7.0±1.2),(1.1±0.7) and(1.3±0.8 );while Cobb's angle separately was (44.1±6.9),(10.9±3.1) and(11.5±2.8);there was significant difference in VAS score and Cobb's angle between preoperative and 2 weeks after operation(P<0.05);while no significant difference between 2 weeks and 1 year after operation(P>0.05). Eighteen cases met the standard of osseous fusion,1 case occurred nonunion,but not looseness 1 year after operation. Nerve function:3 cases changed grade E from 4 cases with grade D,2 cases with grade C changed to grade D,1 case with grade B changed to grade C. Conclusion:Posterior osteotomy and long-segment internal fixation for the treatment of senile thoracolumbar kyphotic deformity can receive a good short-time effects.