• 川北醫(yī)學院附屬醫(yī)院骨科（四川南充，637000）;

【摘要】　目的　 探討經(jīng)后路全脊截骨聯(lián)合椎弓根螺釘治療胸腰椎脊柱后凸畸形的手術評估和臨床療效。　方法　 2004年4月－2010年6月采用后路脊椎截骨椎弓根螺釘內(nèi)固定治療脊柱后凸畸形15例，其中男11例，女4例；年齡16~61歲，平均49歲。陳舊性胸腰椎骨折后凸10例，結核后凸3例，椎體發(fā)育不良2例；后凸頂點：胸9椎體1例，胸11椎體3例，胸12椎體4例，腰1椎體5例，腰2椎體2例。脊柱后凸Cobb角35~61°，平均46°。Frankel分級：E級2例，D級8例，C級4例，B級1例。　結果　 術中出血800~1 800 mL，平均1 000 mL；術中1例左側胸神經(jīng)根損傷；1例術后雙下肢肌力感覺減退。15例患者均獲隨訪，隨訪時間10~30個月，平均12個月。術后6個月Cobb角5~10°，平均矯正率86.5%。術后6~10個月X線片顯示截骨平面骨性愈合，術后神經(jīng)功能恢復情況，除1例B級恢復至D級外，其余為E級。內(nèi)固定物無松動、斷裂和糾正度數(shù)丟失等并發(fā)癥。　結論　 經(jīng)后路脊柱截骨聯(lián)合椎弓根螺釘內(nèi)固定具有減壓、矯形同時進行，矯正度數(shù)大，并發(fā)癥少，臨床效果明顯。
【Abstract】　Objective　 To explore the surgery assessment and clinical outcome of the treatment for thoracolumbar kyphosis by whole posterior spinal osteotomy combined with pedicle screw.　Methods　 Fifteen patients including 11 males and 4 females with kyphosis were treated by posterior spinal osteotomy combined with pedicle screw from April 2004 to June 2010. The age of them ranged from 16 to 61 years old averaging at 49. There were 10 cases of old thoracolumbar fracture kyphosis, 3 cases of tuberculosis kyphosis, and 2 cases of poor vertebral growth. As for kyphosis vertices, there were 1 case of T9, 3 cases of T11, 4 cases of T12, 5 cases of L1, and 2 cases of L2. Kyphosis Cobb angle ranged from 35° to 61°, averaging at 46°. Based on Franke Grade, there were 2 grade E cases, 8 grade D cases, 4 grade C cases, and 1 grade B case.　Results　 Intraoperative blood loss was from 800 to 1 800 mL with an average of 1 000 mL; There was 1 case of left thoracic nerve root injury during operation and 1 case of lower extremity muscle strength hypoesthesia after operation. All the 15 patients were followed up for 10 to 30 months with an average time of 12 months. Six months after surgery, Cobb angle ranged from 5° to 10°, with an average correction rate of 86.5%. Six to ten months after osteotomy, X ray showed a good bone healing condition. As for the recovery status of neurological function after surgery, All patients recovered to grade E except 1 patient who returned to grade D from grade B. No such complications as fixation without loosening, fracture or loss of correction degree occurred.　Conclusion　 In posterior spinal osteotomy combined with pedicle screw fixation, decompression and correction can be carried out at the same time to correct a large degree of kyphosis with few complications. The clinical effect is obvious.

引用本文： 蔣成,蔣萍,蔚芃. 后路全脊椎截骨聯(lián)合椎弓根螺釘治療胸腰椎脊柱后凸畸形. 華西醫(yī)學, 2011, 26(7): 1035-1037. doi: 復制

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1. 　黨耕町, 吳之廉. 黃家駟外科學[M]. 7版. 北京: 人民衛(wèi)生出版社, 2009: 2733-2749.
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3. 　趙建新. 全脊柱截骨術使脊髓縮短對脊髓功能影響的臨床觀察[J]. 中國脊柱脊髓雜志, 1997, 7(5): 196-198.
4. 　鄒德威, 吳繼功, 馬華松, 等. 半椎體切除治療先天性脊柱側后凸畸形[J]. 中國脊柱脊髓雜志, 2008, 18(3): 191-195.
5. 　Bridwell KH, Lewis SJ, Lenke LG, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance[J]. J Bone Joint Surg Am, 2003, 85-A(3): 454-463.
6. 　Kawahara N, Tomita K, Baba H, et al. Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach[J]. Spine (Phila Pa 1976), 2001, 26(4): 391-402.
7. 　Kubiak EN, Moskovich R, Errico TJ, et al. Orthopaedic management of ankylosing spondylitis[J]. Am Acad Orthop Surg, 2005, 13(4): 267-278.
8. 　阮永平, 胡勇, 何賢峰, 等. 經(jīng)后路頂椎椎弓根全椎體截骨矯正胸腰椎后凸畸形[J]. 脊柱外科雜志, 2009, 7(6): 336-340.
9. 　Bridwell KH. Decision making regarding smith-petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity[J]. Spine (Phila Pa 1976), 2006, 31(Suppl 19): S171-S178.
10. 　Boachie-Adjei O, Ferguson JA, Pigeon RG, et al. Transpedicular lumbar wedge resection osteotomy for fixed sagittal imbalance: surgical technique and early results[J]. Spine (Phila Pa 1976), 2006, 31(4): 485-492.
11. 　賈全章, 高吉昌, 張承敏, 等. 全脊柱截骨USS 系統(tǒng)內(nèi)固定治療脊柱后凸[J]. 中國修復重建外科雜志, 2003, 17(4): 276-278.
12. 　王慧敏, 譚明生, 陳文治, 等. 經(jīng)后路椎弓根截骨短節(jié)段椎弓根釘內(nèi)固定治療脊柱后凸畸形[J]. 中國修復重建外科雜志, 2006, 20(11): 1083-1086.
13. 　李平元, 張衛(wèi), 羅國, 等. 經(jīng)椎弓根椎體楔形截骨術治療胸腰椎陳舊性骨折伴后凸畸形[J]. 中國骨與關節(jié)損傷雜志, 2006, 21(5): 390-391.
14. 　機建國, 邱貴興, 于斌, 等. 后半椎體切除治療先天脊柱側后凸的初步結果[J]. 中華骨科雜志, 2006, 26(3): 156-160.
  1. 1. 　黨耕町, 吳之廉. 黃家駟外科學[M]. 7版. 北京: 人民衛(wèi)生出版社, 2009: 2733-2749.
  2. 2. 　Stokes IA. Three-dimensional terminology of spinal deformity. a report presented to the scoliosis research society by the scoliosis research society working group on 3-D terminology of spinal deformity[J]. Spine (Phila Pa 1976), 1994, 19(2): 236-248.
  3. 3. 　趙建新. 全脊柱截骨術使脊髓縮短對脊髓功能影響的臨床觀察[J]. 中國脊柱脊髓雜志, 1997, 7(5): 196-198.
  4. 4. 　鄒德威, 吳繼功, 馬華松, 等. 半椎體切除治療先天性脊柱側后凸畸形[J]. 中國脊柱脊髓雜志, 2008, 18(3): 191-195.
  5. 5. 　Bridwell KH, Lewis SJ, Lenke LG, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance[J]. J Bone Joint Surg Am, 2003, 85-A(3): 454-463.
  6. 6. 　Kawahara N, Tomita K, Baba H, et al. Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach[J]. Spine (Phila Pa 1976), 2001, 26(4): 391-402.
  7. 7. 　Kubiak EN, Moskovich R, Errico TJ, et al. Orthopaedic management of ankylosing spondylitis[J]. Am Acad Orthop Surg, 2005, 13(4): 267-278.
  8. 8. 　阮永平, 胡勇, 何賢峰, 等. 經(jīng)后路頂椎椎弓根全椎體截骨矯正胸腰椎后凸畸形[J]. 脊柱外科雜志, 2009, 7(6): 336-340.
  9. 9. 　Bridwell KH. Decision making regarding smith-petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity[J]. Spine (Phila Pa 1976), 2006, 31(Suppl 19): S171-S178.
  10. 10. 　Boachie-Adjei O, Ferguson JA, Pigeon RG, et al. Transpedicular lumbar wedge resection osteotomy for fixed sagittal imbalance: surgical technique and early results[J]. Spine (Phila Pa 1976), 2006, 31(4): 485-492.
  11. 11. 　賈全章, 高吉昌, 張承敏, 等. 全脊柱截骨USS 系統(tǒng)內(nèi)固定治療脊柱后凸[J]. 中國修復重建外科雜志, 2003, 17(4): 276-278.
  12. 12. 　王慧敏, 譚明生, 陳文治, 等. 經(jīng)后路椎弓根截骨短節(jié)段椎弓根釘內(nèi)固定治療脊柱后凸畸形[J]. 中國修復重建外科雜志, 2006, 20(11): 1083-1086.
  13. 13. 　李平元, 張衛(wèi), 羅國, 等. 經(jīng)椎弓根椎體楔形截骨術治療胸腰椎陳舊性骨折伴后凸畸形[J]. 中國骨與關節(jié)損傷雜志, 2006, 21(5): 390-391.
  14. 14. 　機建國, 邱貴興, 于斌, 等. 后半椎體切除治療先天脊柱側后凸的初步結果[J]. 中華骨科雜志, 2006, 26(3): 156-160.