改良经椎弓根截骨矫形术治疗陈旧性胸腰椎骨折伴后凸畸形

目的评价改良经椎弓根截骨矫形术(transpedicular subtraction osteotomy,PSO)治疗陈旧性胸腰椎骨折伴后凸畸形的临床效果和安全性。方法回顾分析本院2008年1月~2012年10月采用改良PSO治疗的16例陈旧性胸腰椎骨折伴后凸畸形患者临床资料,对所有患者的矫正情况、置入钛网的高度进行随访,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)对腰椎功能进行评估。结果随访12~24个月,平均18.9个月,手术时间190~305 min,平均220 min,术中出血量1 400~2 450 m L,平均1 740 m L。所有患者术后均获得功能及自我形象的改善,腰痛VAS评分下降了(6.3±1.4)分,ODI下降了(52.12±7.43)%,获得34.6°±3.2°的后凸角的矫正,末次随访时矫正度数丢失1.6°。融合率为87.5%。1例患者出现大腿前侧皮肤麻木,术后3个月随访痊愈。结论改良PSO治疗陈旧性胸腰椎骨折伴后凸畸形安全、有效。

Modified pedicle subtraction osteotomy for thoracolumbar old fracture with kyphosis

Objective To evaluate the efficacy and safety of modified pedicle subtraction osteotomy for thoracolumbar old fracture with kyphosis. Methods From January 2008 to October 2012, 16 patients of thoracolumbar kyphosis underwent modified pedicle subtraction osteotomy were reviewed. Preoperative and postoperative kyphotic Cobb's angle, visual analogue scale(VAS) score of back pain, Oswestry disability index(ODI), as well as titanium mesh height inserted, the incidence of complication were accessed. Results Mean follow-up duration was 18.9 months. Average operative time was 220 min(190-305 min) and average bleeding was 1 740 mL(1 400-2 450 mL). All the patients were significantly improved in function and self-image, and obtained kyphosis correction with 34.6°± 3.2°. VAS score of low back pain was decreased by 6.3 ± 1.4, ODI was dropped (52.12 ± 7.43)%, the final follow-up degree of correction lost 1.6°. Fusion rate was 87.5%. One patient suffered anterior thigh numbness and get recovery after 3 months of follow-up. Conclusion Modified pedicle subtraction osteotomy is a safe and effective technique for the treatment of old fracture with kyphosis.