Ponte截骨联合椎间隙颗粒骨打压植骨治疗胸腰椎半椎体后凸畸形

发布时间：2018-05-04 21:56

本文选题：半椎体 + 椎间隙颗粒骨打压植骨　；参考：《中国矫形外科杂志》2017年07期

【摘要】：[目的]探讨Ponte截骨联合椎间隙颗粒骨打压植骨矫正胸腰椎半椎体后凸畸形的有效性与安全性。[方法]2013年6月~2016年9月,手术治疗先天性胸腰椎半椎体后凸畸形15例,男9例,女6例;年龄14~35岁,平均(24.5±7.1)岁。T_(11)2例,T_(12)4例,L_13例,L_25例,L_31例。其中1例为初次手术失败,余为初次手术,均存在进行性加重的腰背部疼痛、后凸畸形,2例存在不同程度的神经功能障碍。采用Ponte截骨后刮除半椎体上下椎间盘得以松解椎间隙,完整保留前纵韧带及尽量保留骨性终板,在充分松解半椎体上下椎间隙的基础上行椎间隙内颗粒骨打压植骨实现初步矫形,再利用矫形棒进行二次矫形矫正后凸畸形。观察指标包括手术时间、出血量、后凸Cobb角变化、植骨融合情况、视觉模拟评分(visual analog scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、ASIA神经功能分级及并发症。[结果]15例患者均获得18~34个月的随访,平均(21.2±11.3)个月。随访18个月时均获得骨性融合。脊柱局部后凸角由术前的平均44.3°±13.5°(28°~57°)改善为术后平均7.5°±8.3°(-6°~12°),平均矫正率为82.3%。末次随访时VAS、ODI评分与术前比较均有明显改善,差异均有统计学意义(P0.01)。ASIA神经功能分级:术后1例患者由C级转为D级、1例由D级转为E级。[结论]应用Ponte截骨联合椎间隙颗粒骨打压植骨治疗胸腰椎半椎体后凸畸形具有矫正角度满意、融合率高、手术创伤小、神经并发症少等优势,可获得满意的矫形效果与临床疗效。
[Abstract]:[objective] to investigate the efficacy and safety of Ponte osteotomy combined with intervertebral space pellet compression for correction of thoracolumbar hemivertebrae kyphosis. [methods] from June 2013 to September 2016, 15 patients (9 males and 6 females) with congenital thoracolumbar hemivertebrae deformity were treated by surgery. The age was 1435 years old (mean 24.5 卤7.1) years. Among them, one case failed the first operation, the other one was the first operation. There were progressive back pain in all cases, and 2 cases of kyphosis malformation had different degrees of neurological dysfunction. Ponte osteotomy was used to remove the upper and lower intervertebral disc of the hemivertebra to release the intervertebral space, to preserve the anterior longitudinal ligament and to preserve the bony endplate as far as possible. On the basis of fully loosening the upper and lower intervertebral spaces of the hemivertebrae, the primary correction was achieved by pressing the granular bone in the intervertebral space, and the secondary correction of kyphosis was carried out with the orthopedic bar. The parameters included operation time, bleeding volume, change of kyphosis Cobb angle, fusion of bone graft, visual analog scale and visual analogue score, visual analog disability index, Oswestry disability index, neurologic grade and complications. [results] Fifteen patients were followed up for 18 to 34 months, with an average of 21.2 卤11.3 months. Bone fusion was obtained at 18 months follow-up. The local kyphosis angle was improved from preoperative mean 44.3 掳卤13.5 掳to mean 7.5 掳卤8.3 掳6 掳6 掳12 掳and the average correction rate was 82.3%. At the last follow-up, Vasco ODI scores were significantly improved compared with those before operation, and the differences were statistically significant (P 0.01). Asia neurological function grade: one patient changed from C grade to D grade and 1 case changed from D grade to E grade after operation. [conclusion] Ponte osteotomy combined with intervertebral space granulated bone compression in the treatment of thoracolumbar hemivertebra kyphosis has the advantages of satisfactory correction angle, high fusion rate, small surgical trauma and less nerve complications. Satisfactory orthopedic effect and clinical effect can be obtained.
【作者单位】：河南省人民医院骨科郑州大学人民医院;
【基金】：河南省卫生厅普通科技攻关项目(编号:201203106)
【分类号】：R687.31

【参考文献】