【摘要】 目的 探討經后路全脊截骨聯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，術后神經功能恢復情況，除1例B級恢復至D級外，其余為E級。內固定物無松動、斷裂和糾正度數丟失等并發癥。 結論 經后路脊柱截骨聯合椎弓根螺釘內固定具有減壓、矯形同時進行，矯正度數大，并發癥少，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.
【摘要】 目的 探討經皮脊柱后凸成形手術中骨水泥的應用療效。 方法 2008年10月-2010年10月，應用注射用Ⅲ型丙烯酸樹脂骨水泥及其椎體成形系統，采取經皮脊柱后凸成形術治療40例椎體疾病患者。其中男5例，女35例；年齡53～84歲，平均65歲。老年骨質疏松性椎體壓縮骨折37例，椎體惡性腫瘤2例，椎體血管瘤1例。采用視覺模擬評分（visual analogue scale，VAS）對患者手術前后疼痛程度的改善情況進行評分統計，并觀察術中及術后并發癥的發生情況。 結果 患者出院前行脊柱正、側位透視，發現椎體內骨水泥分布良好；3例有少量骨水泥向椎體外滲漏現象，但均無臨床癥狀。所有患者獲隨訪1～12個月，平均8個月。腰背部疼痛均明顯緩解或消失，日常生活質量大大提高。術前VAS評分為（8.30±0.48）分，術后3 d、1個月及末次隨訪時VAS評分分別為（3.11±0.41）、（2.50±0.36）、（2.50±0.36）分，與術前比較差異均有統計學意義（Plt;0.05）。 結論 骨水泥應用于經皮脊柱后凸成形手術中可取得很好療效，固化的骨水泥對脊柱起到很好的支撐、穩定作用。【Abstract】 Objective To assess the clinical effect of using bone cement in percutaneous kyphoplasty. Methods From October 2008 to October 2010, type Ⅲ Acrylic resin bone cement and the system of vertebroplasty were used in percutaneous kyphoplasty (PKP) to treat 40 patients. There were 5 males and 35 females with an average of 65 years old (53-84 years). There were 37 older patients with osteoporotic vertebral compression fracture, 2 cases of vertebral tumor and one hemangioma. Visual analogue scale (VAS) was used to evaluate the pain before and after the operation. The complications in and after the operation were also recorded. Results Before discharge, posterior-anterior and lateral X-ray films were taken to evaluate the distribution of bone cement. Three patients showed a little bone cement leakage from the vertebral body, but no clinical symptoms were found. All patients were followed for 1 to 12 months with an average of 8 months. Pain in the back decreased obviously or disappeared, and the qualities of daily life were improved greatly. The score of VAS was (8.30±0.48) before the operation, and (3.11±0.41), (2.50±0.36), and (2.50±0.36) 3 days, 1 month after the operation, and during the last follow-up, respectively. Significant differences were found between the VAS score before and after operation (Plt;0.05). Conclusions Good results can be expected when bone cement is used in percutaneous kyphoplasty. Solidified bone cement can effectively support and stablize the spinal column.
