陈旧性胸腰椎骨折后凸畸形的手术治疗

目的探讨陈旧性腰胸椎骨折后凸畸形的手术治疗及效果。方法1998-2007年收治23例陈旧性胸腰椎骨折后凸畸形,男17例,女6例,年龄17～63岁,平均36.5岁,骨折病史1.1～6.5年,平均3.5年。23例均有明显腰背痛病史,其中18例有神经损害,术前影像学检查有不同程度的后凸畸形（后凸角度18°～42°,平均32°）,脊髓压迫及不稳定征象,针对不同的情况选择三种不同的手术方式,其中前路手术15例,后路手术4例,前后路手术4例,比较分析临床效果。结果全部病例均无严重的术中术后并发症,术后患者腰背痛及下肢麻木症状缓解或消失,后凸角度由术前平均32°矫正到术后11°,随访中未发现丢失。结论对陈旧性胸腰椎骨折后凸畸形患者,术前全面评估,有针对性地选择手术方式,可获得良好的临床结果。

Surgical treatment of old thoracolumbral vertebra fracture with kyphosis

Objective To explore the surgical method and clinical effects for the treatment fo old thoracolumbar vertebra fracture with kyphosis. Method 23 patients （17 males and 6 females） with old thoracolumbar fracture with kyphosis from 1998 to 2007. There were all cases with age 17～63years （mean 36.5 years） as well as thoracolumbar vertebral fracture history for 1.1～6.5 years （mean 3.5 years）. All cases complained of severe lower back pain,18 of whom had slight eurologicla deficits. Preoperative radiographic evaluation showed that all cases had various degrees of kyhposis （18°～42°,averaged 32°）,spinal cord compression and vertebra instability. All 23 cases with old thoracolumbar vertebral fracture in which three approaches were used were documented. In these cases,anterior procedure was performed in 15,posterior procedure in 4,combined anterior and posterior procedure in 4. Results No severe complications happened during and after operation. The lower back pain and neurological deficits were improved or disappeared postoperatively. The average kyphosis correction degrees ranged from preoperative 32° to postoperative 11°,No patients symptoms worsened during follow-up. Conclusions The treatment of spinal old fracture with kyphosis is ticklish and controversial. Carfully evaluation of a patient＇s status before helpful to choose a aternative indicated to the patient which can ensure the outcome.