后路椎体截骨撑开植骨固定治疗胸腰椎陈旧性骨折后凸畸形

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1、后路椎体截骨撑开植骨固定治疗胸腰椎陈旧性骨折后凸畸形作者：王栋,刘增霞　贺西京李浩鹏,　徐思越,杨平林,王国毓【摘要】[目的]探讨后路椎体楔形截骨撑开植骨、跨节段固定治疗胸腰椎陈旧性骨折后凸畸形临床特点及并发症。[方法]总结本院2003年6月-2008年5月以来采用后路经椎弓根楔形截骨跨节段固定治疗单节段胸腰椎陈旧性骨折后凸畸形26例，其中男19例，女7例，均为陈旧性胸腰段骨折病例，病程时间平均12.6年，平均24.2(16～45)岁，后凸角均>40°(平均46.4°±3.5°)，均有长期腰痛病史，合并神经症状16例。18例患者采用后路经椎弓根椎体楔形截骨，椎弓

2、根钉棒系统跨节段加压固定矫形，8例患者应用截骨面前方撑开式植骨纠正后凸畸形。将手术前后患者X线片后凸Cobb’s角比较，统计分析，并对术后并发症进行观察。[结果]术后22例患者获随访，随访时间12～48个月(平均34.6个月)，术后后凸Cobb’s角明显改善，矫正角度幅度平均达86.45%±4.56%。1例患者术后出现肠系膜动脉压迫综合征。[结论]该方法术中即可改善后凸畸形，对于畸形矫正幅度满意;椎体前方撑开式植骨可减少脊柱加压短缩，降低脊髓损伤等并发症。【关键词】脊柱后凸;陈旧性骨折;截骨9　　Abstract：[Objective]Toexploretheclin

3、icalcharacterandthetreatmentmethodofwedgeshapedvertebralosteotomy,expandingbonegraftandspanningsegmentpediclescrewrodsystemfixationfromposteriorapproachtothethoracolumbarkyphosiscausedbyoldfracture.[Method]FromJune2003toMay2008，26casesofkyphosisdeformityatthoracolumbarsegmentweretreat

4、edwithwedgeshapedvertebralosteoctomyandlongsegmentpediclescrewrodinternalfixation,including19malesand7femalesandaging16-45years(averageage:24.2years).Allkyphosisdeformitywerecausedbyoldthoracolumbarfractureandpatientssufferedfrombackpain.Theaveragediseasehistorywere12.6years.Allthesig

5、ittalkyphosisCobb’sanglesweremorethan40degreecases.Sixteenpatientscomplicatedwithnervoussymptom.Amongthem18casesweregivenwedgeshapedvertebralosteoctomyandlongsegmentpediclescrewinternalfixation,8casesweregivenexpandingbonegraftinanteriorofvertebraafterosteotomy.Thekyphosisanglesfromrad

6、iographsweregivencomparedbetweenpreandpostoperatively,andcomplicationsweregivenanalysistoo.[Result]Twentytwopatientshadbeenfollowedupfor12-48months(averagetime:34.6months),allpatients’kyphosisangleswerecorrectedsatisfactory,theextendofrightangle9were86.45%±4.56%.Besidesmesentericarter

7、ycompressedsyndromehappenedin1patient,othercomplicationwasrare.[Conclusion]Thismethodcancorrectthekyphosisdeformityimmediatelyinoperation,itscorrectextentislarge,expandingbonegraftinanteriorofvertebraafterosteotomycanreducethespineshortenandspinalcordinjuryrate.　　Keywords：spine