经后路椎间盘椎弓根间截骨矫正胸腰段脊柱后凸畸形

目的 探讨经后路途径矫正胸腰段脊柱后凸畸形安全有效的手术方式.方法 利用改良的经后路椎间盘椎弓根截骨椎弓根钉棒系统固定技术矫正胸腰段脊柱后凸畸形16例,男11例,女5例;年龄13岁～53岁,平均26.5岁.其中陈旧性胸腰椎骨折9例,强直性脊柱炎4例,先天性发育不良2例,椎体结核l例,X线术前Cobb角45°～85.,平均58.1°.后凸畸形部位:T10 2例,T11 2例,T12 6例,L1 3例,L2 3例.主要临床表现为腰背部不同程度疼痛,畸形进行性加重,影响工作和生活.病程4～17年,平均8.5年,所有患者均行I期截骨、植骨融合、椎弓根钉内固定术,术后卧床休息4周,外支具制动3个月.结果 经后路椎间盘椎弓根截骨手术时间平均190min(125～240 min),失血量平均750 ml(450～1 900 ml),48 h引流量平均170 ml(100～280 ml).所有病例均为单节段截骨,截骨过程未发生椎体移位,无脊髓损伤并发症.术后矢状面畸形得到矫正,矫正度数平均55°(44°～76.),矫正率平均83%.随访10～24个月,X线片示内固定牢固,脊柱融合好,无假关节形成,无内固定松动,矫正度未见明显丢失.全部患者外观畸形明显改善,腰背部疼痛消失,生活质量大大提高.结论 Ⅱ期后路经椎间盘椎弓根截骨椎弓根钉棒系统内固定技术可使脊柱后凸畸形得到一次性矫正,降低了神经、血管损伤的发生率,是一种治疗胸腰段脊柱后凸畸形安全有效的外科手术方法.

Abstract：

Objective To explore a safe and effective posterior surgical operation for correction of the horacolumbar kyphotic deformity. Methods The study involved 16 patients with thoracolumbar kyphotic deformity treated with the modified posterior transpedicular-intervertebral disc wedge resection osteotomy and screws-rods internal fixation apparatus.There were 11 males and 5 females at an average age of 26.5 years(13-53 years).The kyphosis deformity was caused by ankylosing spondylit in four patients,old lumbothoracic fracture in nine,vertebral dysplasia in two and vertebral body in one.The preoperative kyphosis Cobb angle was 58.1(45°-85°),with the kyphosis deformity at T10 in two patients,at Thin two,at T12in six,at L1 in three and at L2 in three.The main clinical manifestations were different degrees of lower back pain and progressive aggravation of the deformity,influencing the work and living.The course of disease was 8.5 years(4-17 years).All patients underwent pesteriortotal vertebral osteotomy on the apex vertebra,trails-pedicular fixation combined with correction and fusion,after which the patients stayed in bed for four weeks and received orthosis fixation for three months after operation. Resuits The operation lasted for average 190 minutes(125-240 minutes),with average blood loss of 750 ml(450-1 900 m1).All patients were with single segment cut bone,with no spinal cord injury,neurological injury or hardware failure.The post-operative vertical plane facial deformity was corrected for average 55(44°-76°),wit average correction rate of 83%.The follow-up for 10-24 months showed firm internal fixation on the X-ray film and good fusion ofthe vertebral column,with no pseudoarticulation formation,loosening internal fixation or loss of correction.All the patients obtained obvious improvement in appearance of the deformity,with disappearance of the lower back pain and improvement of the quality of life. Conclusion One stage posterior transpedicular-interverte-bral disc wedge resection osteotomy is all effect and safe surgical technique for correction of horacolumbar kyphotic deformity.

Posterior transpedicular-intervertebral disc wedge resection osteotomy for correction of thoracolumbar kyphotic deformity

Objective To explore a safe and effective posterior surgical operation for correction of the horacolumbar kyphotic deformity. Methods The study involved 16 patients with thoracolumbar kyphotic deformity treated with the modified posterior transpedicular-intervertebral disc wedge resection osteotomy and screws-rods internal fixation apparatus.There were 11 males and 5 females at an average age of 26.5 years(13-53 years).The kyphosis deformity was caused by ankylosing spondylit in four patients,old lumbothoracic fracture in nine,vertebral dysplasia in two and vertebral body in one.The preoperative kyphosis Cobb angle was 58.1(45°-85°),with the kyphosis deformity at T10 in two patients,at Thin two,at T12in six,at L1 in three and at L2 in three.The main clinical manifestations were different degrees of lower back pain and progressive aggravation of the deformity,influencing the work and living.The course of disease was 8.5 years(4-17 years).All patients underwent pesteriortotal vertebral osteotomy on the apex vertebra,trails-pedicular fixation combined with correction and fusion,after which the patients stayed in bed for four weeks and received orthosis fixation for three months after operation. Resuits The operation lasted for average 190 minutes(125-240 minutes),with average blood loss of 750 ml(450-1 900 m1).All patients were with single segment cut bone,with no spinal cord injury,neurological injury or hardware failure.The post-operative vertical plane facial deformity was corrected for average 55(44°-76°),wit average correction rate of 83%.The follow-up for 10-24 months showed firm internal fixation on the X-ray film and good fusion ofthe vertebral column,with no pseudoarticulation formation,loosening internal fixation or loss of correction.All the patients obtained obvious improvement in appearance of the deformity,with disappearance of the lower back pain and improvement of the quality of life. Conclusion One stage posterior transpedicular-interverte-bral disc wedge resection osteotomy is all effect and safe surgical technique for correction of horacolumbar kyphotic deformity.