一期后路椎间隙 松解+Ponte截骨矫形治疗无神经症状胸腰段陈旧性骨折并后凸畸形

目的　评价后路椎间隙 松解+Ponte截骨矫形治疗无神经症状胸腰段陈旧性骨折并后凸畸形的临床疗效。方法　回顾性分析2009年1月至2013年1月,我院采用后路椎间隙 松解+Ponte截骨矫形治疗无神经症状胸腰段陈旧性骨折并后凸畸形患者15例,其中 男10例,女5例;年龄38～52岁,平均44.3岁 。采用视觉模拟评分(visual analogue scale,VAS)及伤残指数( oswestry disability index，ODI)评分评价临床症状的改善情况,测量X线侧位片Cobb角评价后凸畸形的纠正情况，通过CT扫描了解植骨融合情况。结果　所有患者均获随访,随访时间12～39个月,平均18.1个月 。后凸Cobb角术前平均为43.1°,术后8.1°；VAS评分术前6.5+1.42分,术后2.5+0.81分; ODI评分术前平均为37.8+6.09分,术后6.7+2.45分。 术前术后比较差异均有统计学意义(P<0.05)。无血管神经损伤等严重并发症发生,3例出现肋间神经麻痹症状，3月后症状消失；1例出现胸腔积液，经闭式引流治愈；术后随访有一例植骨愈合欠佳，但是无矫正度丢失和内固定断裂表现，余病例复查植骨牢固愈合，无明显矫正度丢失以及内固定失败的并发症，无其它并发症发生。结论　一期后路椎间隙 松解+Ponte截骨矫形治疗无神经症状胸腰段陈旧性骨折并后凸畸形可获得满意的矫形效果,同时可植骨融合,重建脊柱稳定性,并发症少,创伤较小,是胸腰段后凸畸形较理想的治疗方法。

Effect of one-stage posterior intervertebral disc release combined with Ponte osteotomy in treating old thoracolumbar fracture complicated with kyphotic deformity without neurological symptoms

Objectives: To evaluate the clinical effections of posterior intervertebral space release combined with Ponte osteotomy in treating old thoracolumbar fracture complicated with kyphotic deformity without neurological symptoms. Methods Twenty one patients suffering from old thoracolumbar fracture complicated with kyphotic deformity without neurological symptoms were treated with posterior intervertebral space release combined with Ponte osteotomy from January 2009 to January 2013, and the clinical effections were retrospectively analyzed. Among the 15 cases, there were 10 male patients and 5 female patients, with the age ranging from 38 to 52 years old (average 44.3). Visual analogue scale (VAS) and oswestry disability index (ODI) were employed to evaluate the improvement in clinical symptoms. The Cobb angle on the lateral X-ray was determined to evaluate the effect of kyphotic deformity correction. The status of bone graft fusion was judged with CT scan. Results The patients were followed up for 12-39 months, with the average of 18.1 months. The preoperative and postoperative Cobb angles were 43.1° and 8.1°, respectively. The preoperative and postoperative average VAS scores were 6.5 and 2.5, respectively. The preoperative and postoperative average ODI scores were 37.8 and 6.7, respectively. The three comparisons all showed statistically significant differences (P<0.05). There were no severe complications such as vessel and nerve injury. But there were 3 cases presenting with paralysis of intercostal nerve, and the symptom disappeared after 3 months. There was 1 case of pleural effusion, which was relieved by closed drainage. The follow-up found one case of poor bone graft healing, but with no loss of correction or fracture of internal fixation material. In the other 14 cases, the bone graft was well healed, with no obvious loss of correction, failure of internal fixation or other complications. Conclusion Satisfactory decompression and correction effects were obtained in the treatment of old thoracolumbar fracture complicated with kyphotic deformity without neurological symptoms by one-stage posterior intervertebral space release and Ponte osteotomy. Meanwhile, the bone graft was well healed, so that the spinal stability was reconstructed. This method has fewer complications and smaller trauma, so it is an appropriate technique for thoracolumbar kyphotic deformity.