经后路截骨植骨治疗胸腰段骨折后凸畸形伴脊髓损伤

目的探讨胸腰段陈旧性骨折后凸畸形伴脊髓损伤手术治疗方法及疗效。方法回顾1995-03~2004-09手术治疗48例。术前脊柱后凸Cobb角35~58°,平均41.5°,截瘫Frankel级,A级2例,B级2例,C级7例,D级20例,E级17例。均采取后入路手术方法,围脊髓减压,截骨植骨,矫形内固定。结果随访18~60个月,平均42个月。疗效:Cobb角12°±(比术后丢失4°±);截瘫康复A~E级,加重2例,无变化32例,康复增加Ⅰ级14例;腰痛症状40例得到有效改善。结论由于对胸腰段骨折早期处理方法失误,术后过早负重下床活动等,导致后期发生继发性脊柱后凸畸形。采取经后入路手术方法,可有效解除脊髓压迫,矫正脊柱畸形,重建脊柱平衡,促使患者进一步康复。

Via posterior-access decompression of spiral cord, osteotomy, seed bones and rectify for thoracolumbar vertebral fracture with kyphosis and spinal cord injury

Objective To explore the surgical method and clinical effects for chronic thoraco-lumbar vertebral fracture with kyphosis and spinal cord injury.Method Retrospective study was taken in surgical treatment of the 48 cases from 1995-03 to 2004-09. In the preoperative cobb angles of kyphosis ranged from 35° to 58°(mean41.5°); Frankel Grade of paraplegia A,2cases;B,2;C,7;D,20;E,17. All the cases had been treated via posterior access,complete decompression of spinal cord injury, osteotmy and seed bones,rectified for kyphosis and fixed.Result All the patients were followed-up from 18 to 60 months (averaged 42 months). Curative effects showed that cobb angles were 12°±; recuperation of paraplegia from A to E class change, including aggravating in 2 cases,unchanged in 32,increased one class of recovery in 14 cases;obtainment goodish improvement of haunch pain symptom in 40 patients.Conclusion By reason of blunder in forepart treatment at thoraco-lumbar vertebrate fracture and over early movement after operation forepart, induced kyphosis monstrosity in curative later period.Via posterior access surgery can effectively accomplish decompression of spinal cord and rectify of kyphosis and rebuild balance of spine,thus promote better recovery of hasten patients.