摘要目的 探讨小切口Schwab 4级截骨结合经皮微创椎弓根螺钉治疗陈旧性胸腰段骨折伴后凸畸形患者的临床疗效.方法 采用回顾性病例系列研究分析2014年1月-2015年5月收治的14例陈旧性胸腰段骨折伴后凸畸形患者,其中男5例,女9例;年龄58 ～70岁,平均64.5岁.手术距初始骨折时间6～14个月,平均8.6个月.骨折畸形愈合10例,未愈合4例.术前视觉模拟评分(VAS)为6.5 ～10.0分[(8.5±1.1)分].美国脊髓损伤协会(ASIA)分级D级3例.后凸顶椎部位:T126例,L18例.术前局部后凸Cobb角39.5°～47.2°[(42.5±6.0)°].均采用小切口Schwab 4级截骨结合经皮微创椎弓根螺钉治疗.记录手术时间、术中出血量,观察围术期并发症、术后Cobb角、椎间融合情况、内固定情况、脊髓神经功能、VAS等.结果 手术时间(280±50)min,术中失血量(110±70) ml.术中及术后无节段血管或神经功能损伤、硬膜撕裂等并发症.与术前比较,术后局部后凸Cobb角6.2°～12.1°[(9.3±1.7)°](P＜0.05),平均矫正率78.1％.术后3个月CT片示112枚微创螺钉中,螺钉术后穿透率6.3％(7/112),均为1级螺钉.患者术后均获随访14～28.9个月,平均25.2个月.与术前比较,末次随访时局部后凸Cobb角6.0°～13.1°[(9.6±4.1)°](P＜0.05).未见矫正丢失,椎间植骨融合满意,无内固定松动、断裂等并发症.3例术前合并神经功能障碍患者,ASIA分级均恢复至E级.与术前比较,末次随访时腰背部疼痛VAS为(2.6±1.0)分(P＜0.05).结论 小切口Schwab 4级截骨结合经皮微创椎弓根螺钉治疗陈旧性胸腰段骨折伴后凸畸形,矫形效果满意,融合率高,并发症发生率低.

abstractsObjective To analyze the clinical results of mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation for old thoracolumbar compression fractures combined with kyphosis deformity.Methods A retrospective case series study was made on 14 patients with old thoracolumbar compression fractures combined with thoracolumbar kyphosis undergone mini-incision Schwab grade 4 osteotomy plus percutaneous pedicle screw fixation from January 2014 to May 2015.There were 5 males and 9 females,with mean age of 64.5 years (range,58-70 years).The period between injury and surgery ranged between 6 and 14 months (mean,8.6 months).At the time of surgery,the fracture was already healed in 10 patients,while non-healing was found in other 4 patients.Preoperative visual analogue score (VAS) of back pain was (8.5 ± 1.1)points (range,6.5-10 points).Three patients were associated with neurological dysfunction [American Spinal Injury Association (ASIA) grade D].Apex of kyphosis located at T12 in 6 patients and at L1 in 8 patients.Preoperative kyphosis Cobb angle was (42.5 ± 6.0)° (range,39.5°-47.2°).Operation time,blood loss,perioperative complications,postoperative kyphosis Cobb angle,bone fusion,state of implants,neurological function and VAS were determined.Results Operation time was (280 ± 50) min,and blood loss was (110 ±70)ml.No segmental vessels injury,neurological deficit or dural disruption occurred during the surgery and after surgery.Compared to the preoperative detection,kyphosis Cobb angle was improved to (9.3 ±1.7) ° (range,6.2°-12.1 °) after operation (P ＜ 0.05),with the correction rate of 78.1％.Postoperative CT showed 7 screws (6.3％,7/112) were grade 1 screws.The follow-up was lasted for mean 25.2 months (range,14-28.9 months).At the latest follow-up,the kyphosis Cobb angle was (9.6 ±4.1)°(range,6.0°-13.1°),revealing no correction loss.Interbody bone fusion was good,with no instrumentation-related complications observed.Three patients with neurological dysfunction (ASIA grade D) were recovered to ASIA grade E.Compared to the preoperative detection,back pain was improved with the VAS of (2.6 ± 1.0) points at the latest follow-up (P ＜ 0.05).Conclusion Mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation of old thoracolumbar compression fractures with kyphosis deformity can attain satisfactory and reliable efficacy and bone fusion,with low incidence of complications.