Wang Qing, Wang Gaoju, Zhong Dejun, Xiu Peng, Li Sen, Wang Song
Department of Spinal Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan 646000, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Mar;26(3):261-5.
To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis (RPTK) by simultaneous posterior-anterior circumferential releasing, correction and anterior corpectomy with preserved posterior vertebral wall.
Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing, anterior subtotal corpectomy with preserved posterior vertebral wall, correction, strut graft, and short segmental fixation. There were 14 males and 6 females with an average age of 43.2 years (range, 23-63 years). The time between injury and operation was 4 months to 23 years (mean, 1.4 years). The affected locations were T11 in 1 case, T12 in 8 cases, L1 in 10 cases, and L2 in 1 case. The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations. The degrees of low back pain were assessed by Japanese Orthopaedic Association (JOA) scores.
No incision infection, nerve injury, or cerebral spinal fluid leakage occurred. Seventeen patients were followed up 1-5 years with an average of 2.8 years. The JOA score at last follow-up (26.2 +/- 3.9) was significantly improved when compared with the pre-operative score (14.0 +/- 5.7) (t = 4.536, P = 0.001). One patient had aggravation of kyphosis at 3 months postoperatively, who was in stabilized condition after prolonging immobilized time. The Cobb angle was corrected from (43.2 +/- 11.5) degrees preoperatively to (9.8 +/- 5.7) degrees at last follow-up, showing significant difference (P < 0.01). There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up (P < 0.05). The intervertebral height of fractured vertebra was restored to 87.0% +/- 11.2% of adjacent disc height.
Posterior-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satisfactory clinical results, not only in pain relieving, kyphosis correction, vertebral height restoration, and spinal stability restoration, but also in the risk reduce of bleeding and spinal cord disturbance.
通过前后路联合松解、矫正以及保留后壁的前路椎体次全切除手术，评估创伤后僵硬性胸腰段后凸畸形（RPTK）的外科治疗效果。
2004年10月至2010年10月期间，对20例RPTK患者进行后路松解、保留后壁的前路椎体次全切除、矫正、支撑植骨及短节段内固定治疗。其中男性14例，女性6例，平均年龄43.2岁（范围23 - 63岁）。受伤至手术时间为4个月至23年（平均1.4年）。受累节段：T11 1例，T12 8例，L1 10例，L2 1例。分别于术前、术后测量骨折椎体的Cobb角和椎间隙高度。采用日本骨科协会（JOA）评分评估腰背痛程度。
未发生切口感染、神经损伤或脑脊液漏。17例患者获得1 - 5年随访，平均随访2.8年。末次随访时JOA评分（26.2±3.9）较术前评分（14.0±5.7）显著改善（t = 4.536，P = 0.001）。1例患者术后3个月后凸畸形加重，延长固定时间后病情稳定。Cobb角由术前（43.2±11.5）°矫正至末次随访时（9.8±5.7）°，差异有统计学意义（P < 0.01）。骨折椎体椎间隙高度术前与末次随访比较差异有统计学意义（P < 0.05）。骨折椎体椎间隙高度恢复至临近椎间盘高度的87.0%±11.2%。
前后路联合松解及保留后壁的前路椎体次全切除手术可取得满意的临床效果，不仅能缓解疼痛、矫正后凸、恢复椎体高度及脊柱稳定性，还能降低出血及脊髓损伤风险。
