Schmidt S, Thomann K-D, Rauschmann M
Abteilung für Wirbelsäulenorthopädie, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland.
Orthopade. 2010 Mar;39(3):256-63. doi: 10.1007/s00132-009-1543-2.
Due to anatomical characteristics, posttraumatic deformities following spinal injury occur in particular at the transition from the flexible lumbar spine to the rigid thoracic spine. Incorrectly classified vertebral body fractures can lead to the development of posttraumatic kyphosis due to incorrect treatment. It is likewise important to evaluate the integrity of adjacent discs and assess the sagittal index. Management of kyphosis is difficult and requires radiological evaluation following exact planning. Reconstruction of the sagittal anatomical contour is crucial to prevent stress in the compensatory curves. Performing a dorso-ventral or dorso-ventro-dorsal approach, pedicle subtraction osteotomy or an eggshell procedure is also helpful to achieve good correction without anterior reconstructive surgery. The clinical result is not dependent on correct repositioning alone; poor results can be expected in cases with pseudarthrosis, neurological deficits and severe kyphotic deformities. This article gives an overview of pathogenesis, diagnostic steps and therapeutic options for corrective spinal surgery.
由于解剖学特征，脊柱损伤后的创伤后畸形尤其发生在从灵活的腰椎到僵硬的胸椎的过渡部位。椎体骨折分类错误可能因治疗不当导致创伤后驼背的发展。评估相邻椎间盘的完整性并评估矢状指数同样重要。驼背的治疗很困难，需要在精确规划后进行放射学评估。重建矢状面解剖轮廓对于防止代偿曲线中的应力至关重要。采用前后或后前背侧入路、椎弓根截骨术或蛋壳手术也有助于在不进行前路重建手术的情况下实现良好的矫正。临床结果不仅取决于正确的复位；假关节、神经功能缺损和严重驼背畸形的病例可能会出现不良结果。本文概述了脊柱矫正手术的发病机制、诊断步骤和治疗选择。
