后路经椎弓根楔形截骨联合椎弓根螺钉内固定术矫正成人胸腰椎后凸畸形致矢状位失衡的疗效观察

发布时间：2018-12-07 11:17

【摘要】：目的观察并分析后路经椎弓根楔形截骨联合椎弓根螺钉内固定术矫正成人胸腰椎后凸畸形致矢状位失衡的疗效。方法收集2013.03-2015.03期间于大连医科大学附属二院脊柱外科诊断为胸、腰椎后凸患者的临床资料和影像学资料进行回顾性分析。所收集资料中,其中有8例患者行后路经椎弓根楔形截骨联合椎弓根螺钉内固定术。所有患者术前、术后采集影像学资料(X线),根据X线测量TK、LL、PI、PT以及SVA五项相关矢状位平衡的指标;Cobb角度;改良JOA评分;ASIA神经功能分级;VAS疼痛评分;术后患者矫形后的外观、日常活动改善情况以及并发症发生情况。采用电话或门诊等方式对患者进行术后随访,平均随访时间4.8±2.7个月(2-7个月)。结果所收集的8例患者手术均顺利完成。经统计手术时间2.5-5h,平均3.5h;术中出血量600-2500ml,平均1600ml,均采用自体血回输装置。8例患者术后无死亡、瘫痪以及感染发生。术后患者腰背部疼痛、疲惫症状明显缓解、甚至消失,患者表示对矫形后的外观满意,极大提高了生活质量。术前、术后相比TK角变化不明显,LL取得了理想的矫正,LL基本波动在PI±9°,PT值取得了理想的矫正,平均16.5°。SVA均由术前的矢状位失衡状态(x=7.5cm)矫正到矢状位平衡状态(x=4.2cm)。8例患者术后Cobb角度得到明显矫正,平均矫正32.00±9.51度。随访患者的改良JOA评分、VAS评分与术前相比明显降低,而ASIA神经功能分级与术前相比则明显升高。患者矫形后的外观及日常活动与术前相比有明显改善,达到预期的满意效果,而且术后并发症发生率较低。结论后路经椎弓根楔形截骨联合椎弓根螺钉内固定术,手术安全,手术时间较短,出血量相对少,术后并发症发生率较低,矫形后外观满意,日常活动得到明显改善,是一种安全性较高、疗效可靠的矫治成人胸腰椎后凸畸形致矢状位失衡的手术方式。
[Abstract]:Objective to observe and analyze the effect of posterior transpedicular wedge osteotomy combined with pedicle screw fixation on sagittal imbalance caused by thoracolumbar kyphosis in adults. Methods the clinical data and imaging data of patients with thoracolumbar kyphosis diagnosed by spinal surgery in the second affiliated Hospital of Dalian Medical University were collected and analyzed retrospectively. Among the data collected, 8 patients underwent posterior transpedicular wedge osteotomy combined with pedicle screw fixation. Preoperative and postoperative radiographic data were collected from all patients. According to the X-ray measurements of TK,LL,PI,PT and SVA five related sagittal balance indexes; Cobb angle; modified JOA score; ASIA grading; VAS pain score; Postoperative orthopedic appearance, improvement of daily activities and complications. The patients were followed up by telephone or outpatient, the average follow-up time was 4.8 卤2.7 months (2-7 months). Results all the 8 patients were successfully operated. The operative time was 2.5 to 5 hours with an average of 3.5 hours, and the intraoperative blood loss was 600-2500ml, with an average of 1600ml. All the patients were treated with autologous blood transfusion device. There was no death, paralysis or infection in 8 patients after operation. Postoperative pain in the back of the waist, fatigue symptoms, or even disappear, the patient expressed satisfaction with the appearance of orthopedic, greatly improved the quality of life. Before and after operation, the change of TK angle was not obvious, LL got ideal correction, LL fluctuated basically in PI 卤9 掳, and the value of PT got ideal correction. Mean 16.5 掳. SVA was corrected from sagittal imbalance (x=7.5cm) to sagittal balance (x=4.2cm). The angle of Cobb was significantly corrected in 8 patients after operation, with an average correction of 32.00 卤9.51 degrees. The modified JOA score, VAS score and ASIA neurological function score were significantly lower than those before operation. The appearance and daily activities of the patients after orthopedic surgery were significantly improved compared with those before operation, and the expected satisfactory results were achieved, and the incidence of postoperative complications was lower. Conclusion posterior transpedicular wedge osteotomy combined with pedicle screw internal fixation is safe, shorter operation time, less bleeding, lower incidence of postoperative complications, satisfactory appearance after orthopedic surgery, and obvious improvement of daily activities. It is a safe and reliable surgical method for correction of sagittal imbalance caused by thoracolumbar kyphosis in adults.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【相似文献】