经椎弓根“蛋壳”技术治疗陈旧性胸腰椎骨折后凸畸形

目的 探讨经椎弓根"蛋壳"技术治疗陈旧性胸腰椎骨折伴后凸畸形的临床疗效及意义.方法 回顾性分析我院2010年5月至2013年10月采用经椎弓根"蛋壳"技术治疗的12例陈旧性胸腰椎骨折伴后凸畸形患者的病例资料,其中男7例,女5例;年龄为25~57岁,平均为46.5岁.通过手术前后疼痛视觉模拟评分(visual analogue scale,VAS)评价患者的改善情况,并比较胸腰椎椎体后凸Cobb角矫正情况、融合情况、临床疗效等.结果 12例患者的手术时间为160~232 min,平均为215 min;术中出血量为1000~2400 ml,平均为1600 ml.术中有2例患者出现硬膜撕裂,予以修补;1例患者术后切口浅表感染,经1周换药后,转归良好.所有患者均获得1年以上随访,神经功能均得到不同程度的改善.术前、术后1周、术后1年的腰痛VAS评分平均分别为(8.08±1.00)分、(2.25±0.97)分、(1.41±0.51)分;术前、术后1周、术后1年的椎体后凸Cobb角平均为49.08°±11.79°、13.67°±4.23°、14.50°±3.99°.术后1周、术后1年的VAS评分、椎体后凸Cobb角较术前均明显改善(均P<0.05),术后1年与术后1周椎体后凸Cobb角比较,差异无统计学意义(P>0.05).结论 经椎弓根"蛋壳"技术治疗陈旧性胸腰椎骨折伴后凸畸形,矫形效果及临床疗效良好.

Treatment of old thoracolumbar fracture with kyphosis by transpedicular eggshell technique

Objective To discuss the clinical effect and significance of the transpedicular eggshell technique in treating old thoracolumbar fracture combined with kyphosis. Methods From May 2010 to October 2013, the clinical data of 12 cases of old thoracolumbar fracture (7 males and 5 females) treated by transpedicular eggshell technique were reviewed. The patients were at age range of 25-57 years (mean 46.5 years). The improvement of back pain was evaluated with the visual analogue scale (VAS), and the correction of kyphosis cobb angle, the bone fusion and clinical effects were analyzed. Results The average operative time was 215 min (160-232 min) and the average blood was 1600 ml (1000-2400 ml). Dural tear during the operation occurred in 2 cases. Incision infection occurred in 1 case after the operation, and cured after 1 week. All patients were followed up for more than 1 year. Neurological function was improved in all patients. Before and 1 week and 1 year after operation, VAS scores were 8.08±1.00, 2.25±0.97 and 1.41±0.51, respec-tively; kyphosis Cobb angles were 49.08° ± 11.79° , 13.67° ± 4.23° and 14.50° ± 3.99° , respectively. On the postoperative week 1 and year 1, VAS scores and kyphosis Cobb angles were obviously improved as com-pared with those preoperation (P<0.05). There was no significant difference in Cobb angle at 1st week and 1st year postoperation (P>0.05). Conclusion Treatment of old thoracolumbar fracture combined with kyphosis by transpedicular eggshell technique could achieve effective correction and clinical effect.