后路楔形截骨治疗胸腰椎陈旧性骨折伴后凸畸形

目的探讨后路楔形截骨椎弓根钉内固定术治疗胸腰椎陈旧性压缩性骨折伴后凸畸形的临床疗效。方法回顾性分析2007年9月至2011年12月采用后路楔形截骨椎弓根钉内固定术治疗胸腰椎陈旧性压缩性骨折伴后凸畸形患者27例。术前、术后3个月、术后12个月分别采用日本骨科协会(Japanese orthopaedics association,JOA)评分、视觉模拟评分法(visual analogue scale,VAS)评分及测量后凸Cobb角,评价临床症状的改善及后凸畸形的纠正情况。结果 25例获得随访,余2例失访,25例患者临床症状均缓解,后凸畸形得到明显矫正。术后3个月后凸Cobb角(5.1±1.7)°,JOA评分(19.2±2.3)分,VAS评分为(3.5±1.3)分,术前与术后3个月比较差异有统计学意义(P0.05);术后12个月后凸Cobb角(6.4±2.1)°,JOA评分(24.5±3.2)分,VAS评分为(1.7±0.7)分,术后3个月与12个月比较差异无统计学意义(P0.05)。结论采用后路楔形截骨椎弓根钉内固定术能够充分减压、矫正后凸畸形,并具有创伤小、短期内纠正角度无明显丢失等优点,是治疗胸腰椎陈旧性压缩性骨折后凸畸形的理想方法。

Transpedicula Internal Fixation with Posterior Wedge Osteotomy for Treatment Old Compression Thoracolumbar Fracture Combined with Kyphosis

Objective To explore the effect of posterior wedge osteotomy and transpedicula internal fixation in the treatment of the thoracolumbar kyphosis caused by old compression fiaeture. Methods From September 2007 to December 2011, 27 cases of old compression thoracolumbar fracture combined with kyphosis were treated with posterior wedge osteotomy and transpedicula internal fixation. Kyphotic Cobb angle,VAS of back pain,JOA score and the incidence of complication were accessed at pre operative,3 months post-operation and 12 months post-operation. Results 25 patients were followed up. Operative reduction could ease all of their back and lower 1Mbs pain symptoms. All patients＇ kyphosis angles were corrected satisfac- tory. The mean Cobb angle was（5.1 ± 1.7） °,the average VAS score was （3.5 ± 1.3） and the mean JOA score was （ 19.2 ± 2.3 ） 3 months after operation. There were statistical significant differences in tile above indexes between preoperation and 3 months after operation（P 〈 0.05 ）. The mean Cobb angle was（6.4 ± 2.1 ） °, the average VAS score was （ 1.7 ± 0.7 ） and the mean JOA score was （24.5 ± 3.2）at 12 months post-operation. No significant difference was detected between 3 months post- operation and 12 months post-operation （ P 〉 0.05 ）. Conclusion Posterior wedge osteotomy and transpedicula internal fixation can achieve a satisfactory result in dctormity correction and neurological decompression,so it is a stable and feasible method to old compression thoracolumbar fracture.