顶椎楔形截骨术治疗陈旧性胸腰椎骨折伴脊髓损伤

目的探讨顶椎楔形截骨术治疗陈旧性胸腰椎骨折伴脊髓损伤的治疗效果。方法21例陈旧性胸腰椎骨折伴脊髓损伤患者,其中男16例,女5例;年龄19～63岁,平均37.2岁。均在伤后平均30个月(40 d～17年)行顶椎楔形截骨、椎弓根内固定系统固定术。结果术后随访13～26个月,平均17个月。所有患者术后胸腰椎生理弧度良好,随访无角度丢失;15例CT复查显示手术减压满意;手术后Frankel分级恢复1级以上18例;所有患者腰背部疼痛明显减轻。结论顶椎楔形截骨术是治疗陈旧性胸腰椎骨折伴脊髓损伤的一种有效方法,具有入路简单、显露充分、脊髓前后方均可有效减压、后凸畸形矫正满意、手术后伤椎稳定等特点。

"V-shape" osteotomy at the apical vertebrae for the treatment of old thoracolumbar vertebral fracture combined with spinal cord injury

Objective To assess the effectiveness of"V-shape"osteotomy at the apical verte- brae for the treatment of old thoracolumbar vertebral fracture with spinal cord injury.Methods There were 21 patients with old thoracolumbar vertebral fracture combined with spinal cord injury.At an average period of 30 months after injury,they were treated with"V-shape"osteotomy at the level of apical verte- brae for correction and with pedicle screw instrumentation for fixation through a posterior-only approach. Results Mean follow-up was 17 months (range 13 -26 months).No major complication occurred in all patients.Low back pain and neurological deficits were improved and excellent bone fusion was a- chieved.The difference of Cobb angle between pre-operation and post-operation was statistically signifi- cant (P<0.05).Frankel grade restored by>1 degree in 18 cases (85.7%) after operation.No pa- tients had any notable loss of correction between discharge and final follow-up. Conclusions"V- shape"osteotomy at the apical vertebrae is an effective method for the treatment of old thoraeolumbar ver- tebral fracture combined with spinal cord injury,and suitable for incomplete paraplegia patients with both anterior and posterior compression.This method can not only attain better stability after operation but also correct local kyphosis satisfactorily.