保留椎弓根下壁的椎体截骨术治疗陈旧性胸腰椎骨折后凸畸形

目的 评估经后路保留椎弓根下壁椎体截骨术治疗陈旧性胸腰椎骨折后凸畸形的手术方式及其临床疗效.方法 37例陈旧性胸腰椎骨折后凸畸形患者经后路行保留椎弓根下壁椎体截骨术,平均随访38.6个月.术前、术后3个月分别测量胸腰椎后凸Cobb角、截骨区前缘和后缘的高度以及填写视觉模拟疼痛量表（visual analog scale,VAS）.末次随访时测量胸腰椎后凸Cobb角.结果 术前Cobb角为41.6°±7.8°,术后3个月Cobb角为7.8°±4.3°,与术前相比差异有显著统计学意义（P＜0.05）;末次随访时Cobb角为8.6°±4.1°,较术后3个月无明显丢失（P＞0.05）.截骨区前缘高度增加（2.7±0.8）mm.截骨区后缘高度压缩（7.2±3.1）mm.术前、术后3月VAS评分分别为（7.1±2.9）分和（2.5±1.3）分,较术前明显改善（P＜0.05）.结论 保留椎弓根下壁椎体截骨术能够安全有效地矫正胸腰椎后凸畸形,完整地保留了伤椎峡部及下关节突,保持了伤椎与下位脊椎的连续性,减少了截骨区脊椎矢状面的移位,同时也保留了神经根通道的上壁,从而减少了神经根的损伤.

Pedicle subtraction osteotomy by preserving inferior wall of pedicle for treatment of posttraumatic thoracolumbar kyphosis

Objective To evaluate the safety and efficacy of inferior wall preserving-pedicle subtraction osteotomy in treatment of posttraumatic thoracolumbar kyphosis. Methods A total of 37 patients diagnosed with posttraumatic thoracolumbar kyphosis were treated by pedicle subtraction osteotomy with preserving the inferior wall of pedicle. The mean follow-up was 38.6 months. The sagittal Cobb's angle of the thoracolumbar kyphosis, the changes of anterior body height and posterior body height of injured vertebra, and the visual analog scale were evaluated pre-operatively and 3 months post-operatively. The sagittal Cobb's angle of the thoracolumbar kyphosis was evaluated again at the final follow-up.Results The sagittal Cobb's angle was 41.6°±7.8°preoperative, and 7.8°±4.3° at 3 months postoperatively. The difference has statistical significance (P<0.05). The sagittal Cobb's angle at the final follow-up was 8.6°±4.1°. It had no difference compared with that of 3 months postoperatively (P>0.05). The anterior body height of injured vertebra was improved with (2.7±0.8)mm. The posterior body height of injured vertebra was compressed with (7.2±3.1)mm. The VAS score was improved from 7.1±2.9 to 2.5±1.3. The difference had statistical significance (P<0.05).Conclusion It could be safety and efficacy of the treatment of posttraumatic thoracolumbar kyphosis with one-staged pedicle subtraction osteotomy by preserving the inferior wall of pedicle.