单节段“蛋壳”式椎体截骨术矫正胸腰段脊柱后凸畸形

目的研究单节段"蛋壳"式椎体截骨术矫正胸腰段脊柱后凸畸形的临床疗效。方法回顾分析2002年6月~2006年6月收治的骨折后陈旧性胸腰段椎体后凸畸形患者共21例,既往治疗包括非手术治疗8例,后路手术治疗13例。本组所有患者均有不同程度的腰背痛,疼痛的VAS评分为4.3~7.5分,平均5.6分;神经损伤程度按照Frankel分级进行评定,A级5例,B级3例,C级7例,D级2例,E级4例。本组后凸畸形的Cobb角为28°~75°,平均48°,后凸顶端均为原骨折椎体节段,所有患者均采用后路单节段"蛋壳"技术于后凸顶椎处进行椎体截骨,通过椎弓根固定系统加压固定。观察手术前后后凸畸形的矫正率、疼痛VAS评分及神经功能的恢复。结果所有患者均获得随访,随访6~48个月,平均22个月。手术平均用时212min(128~360min),平均出血量为800mL(400~2200mL)。术后后凸角平均为13°,平均矫正约35°;腰背部疼痛均有明显缓解,术后随访VAS评分平均2.3分(1.0~3.5分),比术前平均降低3.3分。结论单节段"蛋壳"式椎体截骨术截骨后前中后三柱均为骨性接触,融合率高,矫正效果可靠(平均35°),避免了前方大血管损伤的危险,此术式在矫正胸腰段脊柱后凸畸形这一方面是一种安全有效的方法。

Single-level vertebrae "Eggshell" osteotomy for the correction of kyphotic deformity of the thoracolumbar spine

Objective To Evaluate the clinical outcomes of single-level "eggshell" osteotomy for the treatment of obsolete kyphotic deformity of the thoracolumbar spine. Methods From June 2002 to June 2006, 21 cases with thoracolumbar kyphotic deformity after spine fracture were treated with single-level "eggshell" osteotomy. The earlier managements included 13 cases with surgeries through posterior approaches, and the other 8 with nonoperative methods.The preoperative VAS was from 4.3 to 7.5,with a mean scale of 5.6. Neurological deficit was estimated according to Frankel classification: 5 cases as Frankel A, 3 as Frankel B, 7 as Frankel C, 2 as Frankel D and 4 as Frankel E. The mean preoperative Cobb angle was 48°, ranging form 28° to 75°. The surgery of eggshell consisted of transpedicular eggshell technique and osteotomy of the apex vertebra, and the stability was achieved by transpedicular screw system. The deformity correction rate, postoperative VAS and neurological function were evaluated. Results All the patients were followed up from 6 months to 4 years with a mean of 22 months. The mean operation time was 212 min(128-360 min) and the average blood loss was 800 mL(400-2 200 mL). The mean postoperative Cobb angle was 13° with an average deformity correction of 35°. Back pain was relieved in all 21 patients. The postoperative VAS decreased from 5.6 preoperatively to 2.3. Conclusion Single-level vertebral "Eggshell" osteotomy is recommended because of the advantages of satisfied rate of bony fusion and reliable correction of the deformity, especially the lower risk of the anterior blood vessel injury. It can be an effective and safe alternative for the correction of kyphotic deformity of the thoracolumbar spine.