• 瀘州醫(yī)學(xué)院附屬醫(yī)院脊柱外科（四川瀘州，646000）;

【摘 要】 目的  探討后前路聯(lián)合環(huán)形松解、保留椎體后壁的短節(jié)段固定融合治療創(chuàng)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(lián)合環(huán)形松解、保留椎體后壁的椎體次全切除、矯形植骨短節(jié)段內(nèi)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(shù)時(shí)間4個(gè)月～23年，平均1.4年。病變節(jié)段：T11 1例，T12 8例，L1 10例，L2 1例。測(cè)量手術(shù)前后Cobb角、骨折椎體椎間高度，采用日本骨科協(xié)會(huì)（JOA）評(píng)分評(píng)價(jià)腰背疼痛。 結(jié)果  術(shù)后無(wú)切口感染、神經(jīng)損傷和腦脊液漏等并發(fā)癥發(fā)生。17例獲隨訪，隨訪時(shí)間1～5年，平均2.8年。1例患者術(shù)后3個(gè)月后凸加重，經(jīng)延長(zhǎng)制動(dòng)時(shí)間獲得穩(wěn)定。末次隨訪時(shí)JOA腰背痛評(píng)分為（26.2 ± 3.9）分，較術(shù)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(shù)前（43.2 ± 11.5）°比較，差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.01）；骨折椎體椎間高度較術(shù)前顯著改善（P  lt; 0.05），骨折椎體椎間高度恢復(fù)至骨折相鄰椎體椎間高度的87.0% ± 11.2%。 結(jié)論  后前路聯(lián)合環(huán)形松解、保留椎體后壁的短節(jié)段固定融合技術(shù)治療RPTK，對(duì)脊髓干擾小，術(shù)中出血少，有助于增強(qiáng)脊柱穩(wěn)定性和恢復(fù)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(lián)合環(huán)形松解保留椎體后壁治療創(chuàng)傷后僵硬性胸腰椎后凸畸形. 中國(guó)修復(fù)重建外科雜志, 2012, 26(3): 261-265. doi: 復(fù)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(shù)治療胸腰椎爆裂骨折. 中華創(chuàng)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. 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. 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. 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. 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. 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. 6. Colley DP, Dunsker SB. Traumatic narrowing of the dorsolumbar spinal canal demonstrated by computed tomography. Radiology, 1978, 129(1): 95-98.
  7. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 17. 王清, 王松, 王高舉, 等. 保留椎體后壁的前路技術(shù)治療胸腰椎爆裂骨折. 中華創(chuàng)傷雜志, 2011, 27(5): 413-417.
  18. 18. Buchowski JM, Kuhns CA, Bridwell KH, et al. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J, 2008, 8(4): 666-677.
  19. 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. 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. 21. Khoueir P, Oh BC, Wang MY. Delayed posttraumatic thoracolumbar spinal deformities: diagnosis and management. Neurosurgery, 2008, 63(3 Suppl): 117-124.