后路截骨矫形手术治疗陈旧结核性脊柱后凸的可行性探讨

目的探讨后路截骨矫形手术治疗陈旧结核性脊柱后凸可行性。方法选择锦州市传染病医院、北京胸科医院收治的陈旧性结核性脊柱后凸患者30例的临床资料，其中后凸角度〈70°12例患者（A组）给予截骨＋闭合矫形治疗，后凸角度〉70°多椎体融合18例（B组）行后凸融合节段截骨＋双轴旋转矫形＋前柱重建，患者术后每6个月随访1次，均完成2年随访。观察患者脊柱后凸角度改变情况及脊柱矢状位平衡情况，采用Frankel分级评定患者脊髓神经功能，功能障碍指数（ODI）评定患者生活质量，采用满意指数（PSI）评价患者满意度。结果术后随访显示全部患者脊柱后凸角度和腰椎前凸角均较治疗前明显改善，前后比较差异有统计学意义（P〈0．05）：脊柱总体矢状位平衡者较术前明显增加（P〈0．05），患者Frankel分级及ODI评分较术前明显好转（P〈0．05）。患者对治疗总体满意度为93．3％。A、B组后凸矫正率差异无统计学意义（P〉0．05）。结论陈旧结核性脊柱后凸患者根据后凸程度不同选择后路截骨矫形手术效果良好，矫正率高，可有效改善生活功能障碍情况及神经功能．临床可行。

Feasibility study of posterior osteotomy correction surgical treatment of tuberculous kyphosis

Objective To explore feasibility of posterior osteotomy correction surgical treatment of old tuberculous kyphosis. Methods The clinical data of 30 cases of the old tuberculous patients with kyphosis in our hospital were selected, 12 cases of patients with the kyphosis angle 〈 70° （group A） were given Osteotomy ＋ closed orthopedic treatment, 18 cases of patients with kyphosis angle 〉 70°（group B） were given osteotomy ＋ biaxial rotation orthopedic ＋ anterior column reconstruction, patients were followed up every 6 months, and all completed the 2-year follow-up. Kyphosis angle changing and spinal sagittal balance in patients were observed, the spinal cord nerve function, quality of life and satisfaction were assessed by Frankel grade, functional disability index （ODI） and patients satisfaction index （PSI）. Results Postoperative follow-up showed significant improvement in all patients with kyphosis angle and lumbar lordosis compared with before treatment, the difference was statistically significant （P 〈 0.05）; the spina overall sagittal balance increased significantly compared with that preoperative （P 〈 0.05）, patients＂ Frankel grade and ODI score was all significantly improved （P 〈 0.05）. The overall satisfaction of patients on treatment was 93.3%. Kyphosis correction rate of group A and B was not significantly different （P 〉 0.05）. Conclusion The correction rate of posterior osteotomy correction surgical treatment for patients with kyphosis kyphosis according to kyphosis angle is good, which can effectively improve lives obstacle situation and nerve function, clinically feasible.