前路人工椎体撑开矫正胸腰段陈旧性骨折后凸畸形

 目的 探讨前路人工椎体撑开矫正胸腰段陈旧性骨折后凸畸形的有效性与安全性。方法回顾性分析2009年8月至2011年8月应用前路人工椎体撑开矫正胸腰段陈旧性骨折后凸畸形13例患者的病历资料，男4例，女9例；年龄38~62岁，平均(53.3±7.6)岁。T₁₂ 5例，L₁ 6例，L₂ 2例。所有手术均由同组医生完成，采用侧前方入路，术中切除病椎及其上、下椎间盘，保留邻椎骨性终板，置入合适大小的人工椎体，并利用其良好的可延伸性进行主动撑开矫正后凸畸形。随访观察指标包括手术时间、出血量、后凸Cobb角变化、植骨融合情况、疼痛视觉模拟评分(visual analog scale，VAS)及Oswestry功能障碍指数(Oswestry disability index，ODI)及并发症等。结果 所有患者均获得12~28个月的随访，平均(18±5.5)个月。随访12个月时所有患者均获得骨性融合。后凸Cobb角从术前平均33.9°±7.2°(22°~53°)恢复至末次随访时平均7.3°±4.8°(2°~16°)，VAS评分由术前平均(6.4±0.9)分(5~8分)降低至平均(1.5±0.8)分(0~3分)，ODI由术前平均50.5%±10.8%(38%~78%)降低至平均10.9%±4.9%(4%~22%)，差异均有统计学意义。结论 应用人工椎体撑开的前路手术治疗胸腰段陈旧性骨折后凸畸形具有矫正角度大、对神经干扰少、损伤小、固定节段少等优势，可获得满意的矫形效果与临床近期疗效。

Correction of post-traumatic kyphosis in the thoracolumbar spine through an anterior approach using an artificial vertebral body

Objective To investigate the efficacy and safety of anterior approach using an expandable artificial vertebral body for the correction of post-traumatic kyphosis (PTK) in the thoracolumbar spine. Methods From August 2009 to August 2011, 13 patients with PTK in the thoracolumbar spine were treated through an anterior approach using an expandable artificial vertebral body. There were 4 males and 9 females, aged from 38 to 62 years (average, 53.3±7.6 years). The injury levels consisted of ₁₂ in 5 cases, L₁ in 6 cases and L₂ in 2 cases. All the operations were done by a single surgeon group. In the procedure, symptomatic vertebra and its two discs were excised, and the bony endplates were reserved. After putting an expandable artificial vertebral body into the space, the kyphosis was corrected by extending the artificial vertebral body. The operative duration, blood loss, Cobb angle, visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded. Results All patients were successfully followed up for an average time of (18±5.5) months (range, 12 to 28 months). The average Cobb angle was 33.9°±7.2°(range, 22°to 53°)before operation and 7.3°±4.8°(range, 2°to 16°)at final follow-up. The average VAS score was 6.4±0.9(range, 5 to 8)before operation and 1.5±0.8(range, 0 to 3)at final follow-up. The average ODI was 50.5%±10.8%(range, 38% to 78%)before operation and 10.9%±4.9%(range, 4% to 22%) at final follow-up. All patients achieved bony fusion 12 months after operation. Conclusion Application of expandable artificial vertebral body through an anterior approach for PTK in the thoracolumbar spine has several advantages: large angle correction, less interruption of nerve, mini-invasion and less levels fixation. Satisfactory clinical outcome can be achieved.