经椎弓根椎体楔形截骨治疗胸腰椎陈旧性骨折伴后凸畸形23例

背景：迟发性创伤后胸腰椎后凸畸形常引起下腰痛及椎管骨性压迫。为了消除疼痛及改善神经功能，常需手术治疗，其目标是矫正畸形，稳定脊柱。但究竟采取何种手术入路仍存在争论。 目的：观察经椎弓根椎体楔形截骨治疗胸腰椎陈旧性骨折伴后凸畸形的疗效。 方法：回顾性分析2004-01/2006-12南华大学附属第一医院脊柱外科收治的胸腰椎陈旧性骨折并后凸畸形患者23例，男14例，女9例；年龄18~60岁，平均36岁；术前腰椎功能损伤程度按照JOA评分标准评定为(11.02±1.24)分，胸腰段后凸畸形Cobb角为(37.43±3.76)°。23例患者均采用经椎弓根椎体截骨、椎管减压及重建矢状面矫形方法，比较截骨前后腰椎功能恢复、骨愈合情况及有无并发症发生。 结果与结论：23例患者均获得随访，随访时间6~28个月，平均12.5个月。术后腰椎功能及后凸畸形均有明显改善，末次随访JOA评分为(14.04±2.12)分，Cobb角为(11.02±3.58)°，与术前相比差异均有显著性意义(P < 0.05)。截骨面均于术后6个月骨性愈合，无假关节形成及矫正丢失等并发症。提示经椎弓根椎体楔形截骨可获得满意的后凸畸形矫正和神经减压，可促使腰椎功能恢复。

Transpedicular decompression and pedicle fixation for treatment of obsolete thoracolumbar vertebral fractures combined with kyphosis deformity in 23 cases

BACKGROUND: Posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fractures, which needs surgery treatment. However, the choice of approach method is an argument. OBJECTIVE: To explore the therapeutic effect of transpedicular decompression and pedicle fixation for the treatment of obsolete thoracolumbar vertebral fractures combined with kyphosis deformity. METHODS: A total of 23 cases with obsolete thoracolumbar fractures combined with kyphosis admitted at the Department of Spinal Surgery, First Affiliated Hospital, University of South China were selected, including 14 males and 9 females, aged 18-60 years, mean aged 36 years; The JOA scores of patients were (11.02±1.24) points prior to operation, with (37.43±3.76)° Cobb angel. All patients were treated by transpedicular decompression and pedicle fixation. The functional recovery of lumbar vertebra, bone healing, as well as the complications was compared before and after operation. RESULTS AND CONCLUSION: All patients were followed-up for 6-28 months with an average of 12.5 months. The lumbar vertebra function and kyphosis deformity was notably improved postoperatively. After treatment, the JOA score and Cobb angle was (14.04± 2.12) points and (11.02±3.58)°, which was obviously different than that of preoperative (P < 0.05). The surfaces of cut bone were healed at 6 months after operation, without complications of pseudoarticulation formation or correction loss. The results suggested that transpedicular decompression and pedicle fixation can achieve a satisfactory result in deformity correction and neurological decompression, which can precipitate the functional recovery.