后前路聯合環形松解保留椎體后壁治療創傷后僵硬性胸腰椎后凸畸形_《中國修復重建外科雜志》

作者：

王清 , 王高舉 , 鐘德君 , 修鵬 , 李森 , 王松

瀘州醫學院附屬醫院脊柱外科（四川瀘州，646000）;

關鍵詞：

創傷后僵硬性胸腰椎后凸畸形環形松解保留椎體后壁

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【摘要】目的 探討后前路聯合環形松解、保留椎體后壁的短節段固定融合治療創傷后僵硬性胸腰椎后凸畸形（rigid post-traumatic thoracolumbar kyphosis，RPTK）的療效。方法 2004年10月－2010年10月收治RPTK患者20例，采用后前路聯合環形松解、保留椎體后壁的椎體次全切除、矯形植骨短節段內固定治療。男14例，女6例；年齡23～63歲，平均43.2歲。外傷至手術時間4個月～23年，平均1.4年。病變節段：T11 1例，T12 8例，L1 10例，L2 1例。測量手術前后Cobb角、骨折椎體椎間高度，采用日本骨科協會（JOA）評分評價腰背疼痛。結果術后無切口感染、神經損傷和腦脊液漏等并發癥發生。17例獲隨訪，隨訪時間1～5年，平均2.8年。1例患者術后3個月后凸加重，經延長制動時間獲得穩定。末次隨訪時JOA腰背痛評分為（26.2 ± 3.9）分，較術前（14.0 ± 5.7）分顯著改善（t=4.536，P=0.001）。胸腰段后凸Cobb角為（9.8 ± 5.7）°，與術前（43.2 ± 11.5）°比較，差異有統計學意義（P lt; 0.01）；骨折椎體椎間高度較術前顯著改善（P lt; 0.05），骨折椎體椎間高度恢復至骨折相鄰椎體椎間高度的87.0% ± 11.2%。結論后前路聯合環形松解、保留椎體后壁的短節段固定融合技術治療RPTK，對脊髓干擾小，術中出血少，有助于增強脊柱穩定性和恢復椎間高度。

引用本文： 王清,王高舉,鐘德君,修鵬,李森,王松. 后前路聯合環形松解保留椎體后壁治療創傷后僵硬性胸腰椎后凸畸形. 中國修復重建外科雜志, 2012, 26(3): 261-265. doi: 復制

1.	Schoenfeld AJ, Wood KB, Fisher CF, et al. Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech, 2010, 23(7): e1-8.
2.	Lazennec JY, Neves N, Rousseau MA, et al. Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels. J Spine Disord Tech, 2006, 19(7): 487-494.
3.	Benli IT, Kaya A, Uruc V, et al. Minimum 5-year follow-up surgical results of post-traumatic thoracic and lumbar kyphosis treated with anterior instrumentation: comparison of anterior plate and dual rod systems. Spine (Phila Pa 1976), 2007, 32(9): 986-994.
4.	Wu SS, Hwa SY, Lin LC, et al. Management of rigid post-traumatic kyphosis. Spine (Phila Pa 1976), 1996, 21(19): 2260-2267.
5.	Been HD, Poolman RW, Ubags LH. Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. Eur Spine J, 2004, 13(2): 101, 107.
6.	Colley DP, Dunsker SB. Traumatic narrowing of the dorsolumbar spinal canal demonstrated by computed tomography. Radiology, 1978, 129(1): 95-98.
7.	Kuklo TR, Polly DW, Owens BD, et al. Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine J, 2001, 26(1): 61-66.
8.	Oner FC, van Gils AP, Dhert WJ, et al. MRI findings of thoracolumbar spine fractures: a categorization based on MRI examinations of 100 fractures. Skeletal Radiol, 1999, 28(28): 433-443.
9.	Fukui M, Chiba K, Kawakami M, et al. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 3. Validity study and establishment of the measurement scale: Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association, Japan. J Orthop Sci, 2008, 13(3): 173-179.
10.	Krompinger WJ, Frederickson BE, Mino DE, et al. Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin North Am, 1986, 17(1): 161-170.
11.	Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine (Phila Pa 1976), 2005, 30(7): 787-791.
12.	Dai LY, Yao WF, Cui YM, et al. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma, 2004, 56(2): 348-355.
13.	Meves R, Avanzi O. Correlation among canal compromise, neurologic deficit, and injury severity in thoracolumbar burst fractures. Spine (Phila Pa 1976), 2006, 31(18): 2137-2141.
14.	Mohanty SP, Venkatram N. Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise. Spinal Cord, 2002, 40(6): 295-299.
15.	Wilcox RK, Boerger TO, Hall RM, et al. Measurement of canal occlusion during the thoracolumbar burst fracture process. J Biomech, 2002, 35(3): 381-384.
16.	Kawahara N, Tomita K, Kobayashi T, et al. Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976), 2005, 30(6): 613-620.
17.	王清, 王松, 王高舉, 等. 保留椎體后壁的前路技術治療胸腰椎爆裂骨折. 中華創傷雜志, 2011, 27(5): 413-417.
18.	Buchowski JM, Kuhns CA, Bridwell KH, et al. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J, 2008, 8(4): 666-677.
19.	McCullen G, Vaccaro AR, Ganfin SR. Thoracic and lumbar trauma: rationale for selecting the appropriate fusion technique. Orthop Clin North Am, 1998, 29(4): 813-828.
20.	Sasso RC, Best NM, Reilly TM, et al. Anterior-only stabilization of three-column thoracolumbar injuries. J Spinal Disord Tech, 2005, 18 Suppl: S7-14.
21.	Khoueir P, Oh BC, Wang MY. Delayed posttraumatic thoracolumbar spinal deformities: diagnosis and management. Neurosurgery, 2008, 63(3 Suppl): 117-124.

1. Schoenfeld AJ, Wood KB, Fisher CF, et al. Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech, 2010, 23(7): e1-8.
2. Lazennec JY, Neves N, Rousseau MA, et al. Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels. J Spine Disord Tech, 2006, 19(7): 487-494.
3. Benli IT, Kaya A, Uruc V, et al. Minimum 5-year follow-up surgical results of post-traumatic thoracic and lumbar kyphosis treated with anterior instrumentation: comparison of anterior plate and dual rod systems. Spine (Phila Pa 1976), 2007, 32(9): 986-994.
4. Wu SS, Hwa SY, Lin LC, et al. Management of rigid post-traumatic kyphosis. Spine (Phila Pa 1976), 1996, 21(19): 2260-2267.
5. Been HD, Poolman RW, Ubags LH. Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. Eur Spine J, 2004, 13(2): 101, 107.
6. Colley DP, Dunsker SB. Traumatic narrowing of the dorsolumbar spinal canal demonstrated by computed tomography. Radiology, 1978, 129(1): 95-98.
7. Kuklo TR, Polly DW, Owens BD, et al. Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine J, 2001, 26(1): 61-66.
8. Oner FC, van Gils AP, Dhert WJ, et al. MRI findings of thoracolumbar spine fractures: a categorization based on MRI examinations of 100 fractures. Skeletal Radiol, 1999, 28(28): 433-443.
9. Fukui M, Chiba K, Kawakami M, et al. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 3. Validity study and establishment of the measurement scale: Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association, Japan. J Orthop Sci, 2008, 13(3): 173-179.
10. Krompinger WJ, Frederickson BE, Mino DE, et al. Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin North Am, 1986, 17(1): 161-170.
11. Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine (Phila Pa 1976), 2005, 30(7): 787-791.
12. Dai LY, Yao WF, Cui YM, et al. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma, 2004, 56(2): 348-355.
13. Meves R, Avanzi O. Correlation among canal compromise, neurologic deficit, and injury severity in thoracolumbar burst fractures. Spine (Phila Pa 1976), 2006, 31(18): 2137-2141.
14. Mohanty SP, Venkatram N. Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise. Spinal Cord, 2002, 40(6): 295-299.
15. Wilcox RK, Boerger TO, Hall RM, et al. Measurement of canal occlusion during the thoracolumbar burst fracture process. J Biomech, 2002, 35(3): 381-384.
16. Kawahara N, Tomita K, Kobayashi T, et al. Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976), 2005, 30(6): 613-620.
17. 王清, 王松, 王高舉, 等. 保留椎體后壁的前路技術治療胸腰椎爆裂骨折. 中華創傷雜志, 2011, 27(5): 413-417.
18. Buchowski JM, Kuhns CA, Bridwell KH, et al. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J, 2008, 8(4): 666-677.
19. McCullen G, Vaccaro AR, Ganfin SR. Thoracic and lumbar trauma: rationale for selecting the appropriate fusion technique. Orthop Clin North Am, 1998, 29(4): 813-828.
20. Sasso RC, Best NM, Reilly TM, et al. Anterior-only stabilization of three-column thoracolumbar injuries. J Spinal Disord Tech, 2005, 18 Suppl: S7-14.
21. Khoueir P, Oh BC, Wang MY. Delayed posttraumatic thoracolumbar spinal deformities: diagnosis and management. Neurosurgery, 2008, 63(3 Suppl): 117-124.

《中國修復重建外科雜志》

后前路聯合環形松解保留椎體后壁治療創傷后僵硬性胸腰椎后凸畸形

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《中國修復重建外科雜志》

后前路聯合環形松解保留椎體后壁治療創傷后僵硬性胸腰椎后凸畸形

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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