后路椎体问截骨术在胸腰椎骨折迟发性后凸畸形及强直性脊柱炎假关节形成治疗中的应用

目的：评价后路椎体间截骨术治疗胸腰椎骨折迟发性后凸畸形及强直性脊柱炎假关节形成的初步临床疗效.方法：采用后路椎体间截骨矫形减压植骨融合内固定术治疗胸腰椎骨折迟发性后凸畸形21例及强直性脊柱炎假关节形成患者3例 椎间植骨融合17例,后外侧植骨融合6例,1例截骨矫形后椎管连续性好未植骨.结果：所有患者脊柱畸形均获得良好矫正,Cobb角由术前平均37°（17°～56°）降至术后4°（0°～12°）,术后纠正率为89%.经平均31（6～61）个月随访,全部病例均获得融合,无内固定松动及断裂.患者疼痛改善显著,VAS评分由术前的8.7下降到术后2.4,Oswestry评分由术前的69下降到26,最后随访VAS评分和Oswestry评分分别为2.2和23.Frankle分级B级1例无恢复,C级2例恢复至D级,D级4例恢复至E级 2例括约肌功能性功能障碍者部分改善.结论：经椎体间截骨矫形减压脊柱固定融合术,可以有效完成脊柱后凸的矫形、减压与稳定性重建,临床症状缓解满意,能显著提高患者生活质量.

Posterior Interbody Osteotomy(PIO) for Late Kyphosis Secondary on Thoracolumbar Fractures and Pseudoarthrosis in Ankylosing Spondylitis

Objective：To evaluate the clinical efficacy of posterior interbody osteotomy for late-onset kyphusis secondary on thoraeohunbar fraetures and pseudoarthrosis with kyphosis in patients with ankylosing spondylitis（AS）. Methods：21 eases of thoraeic and lumbar fractures with late-onset kyphosis and 3 cases of ankylosing spondylitis with pseudoarthrosis from May 2002 to June 2007 in our hospital were retrospectively ana- lyzed respectively. Among them, fracture kyphosis T11 in 3 cases, T12 8 cases, L1 6 cases, L2 4 cases, the pseudoarthrosis T10-11 case, T11-12 I ease, L1/2 1 ease. All patients had been performed posterior interbody osteotomy （PIO） ＋ 360° spinal cord decompression ＋ pediele screw fixation, interbody fusion in 17 cases, 6 ca- ses with postcrolatcral fusion and 1 case without bone grant. Results ： All patients had got good correction of de- h）nnity. X fihns showed preoperative average Cobb angle was 37° （ 17° -56°） decreased to postoperative aver- age 4°（0° - 12°） , and the postoperative correction rate was 89 percent. After an average of 31 months （6 -61 months） follow-up, all patients were fused without internal fixation loosening and fracture. Significant improve- ment in all patients with low back pain, VAS score decreased from preoperative 8.7 to postoperative 2.4, Os- weslry score improved from 69 down to 26, the last follow-up VAS score and Oswestry scores were 2.2 and 23. Frankle grade B class 1 palients without recovery,, C-class 2 patients returned to the D class, D class 4 patients recovered to Grade E; 2 eases of sexual dysfunetion sphincter were partially improved. Conclusions：The posterior interbody osteotomy and decompression and spinal fusion fixation can effectively complete the correction, decompression and stability of the reconstruction, and clinical efficacy is satisfying while the patients can significantly improve the quality of life.