改良V形截骨矫正胸腰椎后凸的临床应用分析.docVIP

改良V形截骨矫正胸腰椎后凸的临床应用分析 　　[摘要] 目的 探讨改良V形截骨在矫正胸腰椎后凸的应用。方法 选择因胸腰段后凸而行手术治疗的患者64例，将其分为传统组和改良组，传统手术组30例，男20例，女10例；年龄45～68岁。改良手术组34例，男22例，女12例；年龄53～65岁。分析两组矫正后凸Cobb角及术后并发症。 结果 改良组和传统组矫正后凸Cobb角无明显差异（P0.05），改良组术后胃肠道并发症较传统组发生率明显降低，差异有统计学意义（P0.05）。结论 改良V形截骨术式可以矫正Cobb角80°的脊柱后凸畸形，明显降低胃肠道及血管事件等并发症的发生。 　　[关键词] V形截骨；脊柱后凸；胸腰段 　　[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2014）23-0152-03 　　[Abstract] Objective To explore clinic effect analysis of improved V-shaped osteotomy to correct thoracolumbar kyphosis. Methods A total of 64 patients with thoracolumbar kyphosis were divided into two groups， traditional group and improved group， the traditional surgery group of 30 patients underwent the traditional V-shaped osteotomy， including 20 males and 10 females with an age range of 45 to 68 years. Improved surgery group of 34 patients underwent the improved V-shaped osteotomy， including 22 males and 12 females with an age range of 53 to 65 years. Perioperative complications and Cobb angle of kyphosis were compared between two groups. Results The improved group and traditional group in correction Cobb of kyphosis had no obvious difference（P0.05）， the incidence of postoperative gastrointestinal complications in improved group was obviously lower than traditional group with statistical difference（P0.05）. Conclusion The improved V-shaped osteotomy surgery can correct thoracolumbar kyphosis with cobb angle 80° and the gastrointestinal complications and vascular events can be significantly reduced. 　　[Key words] V-shaped osteotomy； Kyphosis； Thoracolumbar 　　近年来，随着现代生活方式的改变及人口老龄化的加剧，脊柱后凸的发病率不断上升。胸椎及胸腰椎后凸畸形的病因主要有先天性脊柱畸形（如半椎体、分隔不全等）、脊柱侧后凸畸形、胸腰段脊柱骨折、脊柱结核椎体破坏、强直性脊柱炎、休门氏（Scheuermann’s）病、老年性脊柱后凸、椎体肿瘤等。依据脊柱后凸畸形形态又可分为角状后凸畸形和弓状后凸畸形。脊柱后凸畸形不但可导致躯体矢状面平衡丧失及腰椎代偿性过度前凸而引发患者腰背部顽固性疼痛，同时还可造成患者严重的心理障碍及工作与生活上的困难。此外，角状后凸畸形还可导致脊髓损害。对于脊柱严重或僵硬性后凸畸形，手术是唯一有效的办法，但传统V形截骨破坏了前中柱的稳定性，可能会出现机械肠梗阻、胃扩张、大血管破裂等风险[1]。本研究在传统截骨的基础上进行改良，减少了上述并发症的发生，降低了术中术后风险。现将结果报道如下。 　　1 资料与方法 　　1.1 一般资料 　　选择我院2010年5月～2012年6月因退变、强直性脊柱炎、陈旧性腰椎骨折、