Treatment for Thoracolumbar Kyphosis by Whole Posterior Spinal Osteotomy Combined with Pedicle Screw_West China Medical Journal

Authors：

JIANG Cheng , JIANG Ping , WEI Peng

Department of Orthopedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

Keywords：

脊柱后凸畸形; 截骨矫形; 椎弓根螺钉固定

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【摘要】　目的　探讨经后路全脊截骨联合椎弓根螺钉治疗胸腰椎脊柱后凸畸形的手术评估和临床疗效。　方法　 2004年4月－2010年6月采用后路脊椎截骨椎弓根螺钉内固定治疗脊柱后凸畸形15例，其中男11例，女4例；年龄16~61岁，平均49岁。陈旧性胸腰椎骨折后凸10例，结核后凸3例，椎体发育不良2例；后凸顶点：胸9椎体1例，胸11椎体3例，胸12椎体4例，腰1椎体5例，腰2椎体2例。脊柱后凸Cobb角35~61°，平均46°。Frankel分级：E级2例，D级8例，C级4例，B级1例。　结果　术中出血800~1 800 mL，平均1 000 mL；术中1例左侧胸神经根损伤；1例术后双下肢肌力感觉减退。15例患者均获随访，随访时间10~30个月，平均12个月。术后6个月Cobb角5~10°，平均矫正率86.5%。术后6~10个月X线片显示截骨平面骨性愈合，术后神经功能恢复情况，除1例B级恢复至D级外，其余为E级。内固定物无松动、断裂和纠正度数丢失等并发症。　结论　经后路脊柱截骨联合椎弓根螺钉内固定具有减压、矫形同时进行，矫正度数大，并发症少，临床效果明显。
【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.

Citation： JIANG Cheng,JIANG Ping,WEI Peng. Treatment for Thoracolumbar Kyphosis by Whole Posterior Spinal Osteotomy Combined with Pedicle Screw. West China Medical Journal, 2011, 26(7): 1035-1037. doi: Copy

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1. 　党耕町, 吴之廉. 黄家驷外科学[M]. 7版. 北京: 人民卫生出版社, 2009: 2733-2749.
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. 　赵建新. 全脊柱截骨术使脊髓缩短对脊髓功能影响的临床观察[J]. 中国脊柱脊髓杂志, 1997, 7(5): 196-198.
4. 　邹德威, 吴继功, 马华松, 等. 半椎体切除治疗先天性脊柱侧后凸畸形[J]. 中国脊柱脊髓杂志, 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, 何贤峰, 等. 经后路顶椎椎弓根全椎体截骨矫正胸腰椎后凸畸形[J]. 脊柱外科杂志, 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. 　贾全章, 高吉昌, 张承敏, 等. 全脊柱截骨USS 系统内固定治疗脊柱后凸[J]. 中国修复重建外科杂志, 2003, 17(4): 276-278.
12. 　王慧敏, 谭明生, 陈文治, 等. 经后路椎弓根截骨短节段椎弓根钉内固定治疗脊柱后凸畸形[J]. 中国修复重建外科杂志, 2006, 20(11): 1083-1086.
13. 　李平元, 张卫, 罗国, 等. 经椎弓根椎体楔形截骨术治疗胸腰椎陈旧性骨折伴后凸畸形[J]. 中国骨与关节损伤杂志, 2006, 21(5): 390-391.
14. 　机建国, 邱贵兴, 于斌, 等. 后半椎体切除治疗先天脊柱侧后凸的初步结果[J]. 中华骨科杂志, 2006, 26(3): 156-160.

West China Medical Journal

Treatment for Thoracolumbar Kyphosis by Whole Posterior Spinal Osteotomy Combined with Pedicle Screw

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