经后路全脊柱截骨治疗胸腰椎骨折晚期后凸畸形.DOCVIP

临床医学论文-经后路全脊柱截骨治疗胸腰椎骨折晚期后凸畸形 ??????????? 作者：邹庆，杨永宏，楼肃亮，叶虹，张冬生，钱金黔，郑洁 【关键词】? 截骨 　　摘? 要：［目的］评价经后路全脊柱截骨治疗胸腰椎骨折晚期后凸畸形的效果及探讨其手术指征。［方法］28例胸腰椎骨折晚期后凸畸形患者，22例腰背部疼痛剧烈，平卧困难、后凸畸形进行性加重，6例伴有不同程度神经损害症状(Frankel 分级：C级2例，D级4例)；术前后凸Cobb′s角32°～60°，平均475°。均采用经后路全脊柱截骨术式纠正后凸畸形、植骨内固定稳定脊柱，重建脊柱矢状面平衡。［结果］术后Cobb′s角平均68°，胸腰椎后凸畸形纠正率857％，重建脊柱矢状面平衡，神经损害症状恢复(Frankel分级C、D级5例神经功能恢复正常，1例C级恢复至D级)，外观满意；无神经并发症。术后平均随访18个月，平均矫正丢失度数为28°。［结论］对于胸腰椎骨折晚期后凸畸形僵硬、度数50°的中老年患者经后路全脊柱截骨术式是理想选择。 　　关键词：胸腰椎；? 创伤后后凸；? 椎体截骨术；? 脊柱重建 　　Posterior transvertebral osteotomy for posttraumatic thoracolumbar kyphosis 　　Abstract：［Objective］To? evaluate the curative? effect of posterior? transvertebral osteotomy? for? posttraumatic thoracolumbar kyphosis and discuss its indication.［Method］There were 28 cases in which posttraumatic?thoracolumbar?kyphosis were corrected by osteotomy?with?spine shortening through posterior approach.The reduction was fixed by a pedicular instrument.Successful treatment?aimed at achieving satisfactory balance in both of the sagittal and coronal planes.The goals of surgery?were to obtain a solid fusion with a balance spine,to?relieve pain and to prevent further deformity.A?secondary goal is to correct the thoracolumbar curvatures,and in so doing to improve the cosmetic appearece.［Result］The spinal balance was? well maintained or restored and the cosmetic appcarccc was improved obviously.The? average? rate? of? kyphosis correction? was 85.7%.All palients? had? no? nerve? compilations. Average 18 months followup were done,the clinical result was excellent with significant correction of kyphosis and solid vertebral? fusion.［Conclusion］Following the surgical indication, posterior transvertebral osteotomy is demonstrated to be a safe and effective technique for the treatment of posttraumatic thoracolumbar kyphosis. 　　Key words:Thoracolumbar;? Posttraumatic kyphosis;? Transvertebral osteotomy;? Spinal reconstruction 　　胸腰椎骨折早期治疗不当或延误治疗，晚期易出现腰背部疼痛、后凸畸形和神经功能障碍，治疗相当困难。本科采用经后路全脊柱截骨术共治疗该类患者28例，疗效满意。 　　1? 临床资料