经后路L1椎体截骨短节段椎弓根内固定术治疗脊柱后凸畸形

目的探讨L1椎体楔形截骨椎弓根螺钉内固定术矫治胸腰段脊柱后凸畸形的效果。方法56例胸腰段后凸畸形患者，均行经后路L1椎体截骨短节段椎弓根内固定，全部采用单节段截骨。结果本组平均手术时间3．7（2．8～4．6）h，术中平均出血量1980（700—3600）ml。术后后凸角由手术前平均54．5°矫正到16．5°，矫正角度38°。随访6～72个月，其间畸形矫正无明显丢失，除2例出现下肢麻痹外，其余均未出现神经系统并发症。结论L1椎体楔形截骨椎弓根螺钉内固定术矫治脊柱后凸畸形固定可靠，矫形效果满意。

Posterior Wedge Osteotomy of L1 Vertebrae with Transpedicular Fixation for Thoracolumbar Kyphosis

Objective To explore the effect of one-stage posterior wedge osteotomy of L1 vertebrae and transpedicular fixation for correction of thoracolumbar kyphotic deformity. Method 56 cases with kyphotic deformity were conducted wedge osteotomy of L1 and transpedicular fixation via posterior approach. Results The average operative duration was 3.7 hours （ ranged from 2.8 to 4.6 hours）, and the mean intraoperative blood loss was 580 ml （range from 700 to 3 600 ml）. The kyphotic angle was reduced from an average of 54. 5° to 16.5°. No loss of correction, looseness and breakage of internal fixator occurred during the 6 to 72 months follow-up. Except two of lower extremities paralysis, the others were not found neurologic complications. Conclusion Posterior wedge osteotomy of L1 and transpedicular fixation is a safe, reliable and effective therapy for thoracolumbar kyphosis, and can achieve an equivalent effect of apical vertebrae osteotomy.