Kinkpe C V, Onimus M, Sarr L, Niane M M, Traore M M, Daffe M, Gueye A B
Faculté de Médecine, Pharmacie et Odontologie de l'Université Cheikh Anta DIOP, Dakar, Sénégal.
Centre Hospitalier de l'Ordre de Malte (CHOM), Dakar, Sénégal.
Open Orthop J. 2017 Mar 31;11:274-280. doi: 10.2174/1874325001711010274. eCollection 2017.
It has been observed that the correction of severe posttuberculous angular kyphosis is still a challenge, mainly because of the neurologic risk.
Nine patients were reviewed after surgery (mean follow-up 18 months). There were 2 thoracic, 4 thoraco-lumbar and 3 lumbar kyphosis. The mean age at surgery was 23. Clinical results were evaluated by the Oswestry Disability Index (ODI) and by the neurologic evaluation. Preoperative, postoperative and final follow-up X-rays were assessed. The surgery included a posterior approach with cord release and correction by transpedicular wedge osteotomy and widening of the spinal canal.
Average kyphotic angulation was 72° before surgery, 10° after surgery and 12° at follow-up. Three out of four patients with neural deficit showed improvement. Neurologic complications included a transitory quadriceps paralysis, likely by foraminal compression of the root.
A posterior transpedicular wedge osteotomy allows a substantial correction of the kyphosis, more by deflexion than by elongation, with limited neurologic risks. However it is mandatory to widely enlarge the spinal canal on the levels adjacent to the osteotomy, in order to allow the dura to expand backwards.
据观察，重度结核后角状脊柱后凸的矫正仍是一项挑战，主要是因为存在神经风险。
对9例患者术后情况进行回顾（平均随访18个月）。其中有2例胸椎、4例胸腰段和3例腰椎脊柱后凸。手术时的平均年龄为23岁。临床结果通过Oswestry功能障碍指数（ODI）和神经学评估进行评价。对术前、术后及最终随访时的X线片进行评估。手术包括后路手术，行脊髓松解，并通过经椎弓根楔形截骨及扩大椎管进行矫正。
术前平均脊柱后凸角度为72°，术后为10°，随访时为12°。4例有神经功能缺损的患者中有3例病情改善。神经学并发症包括一过性股四头肌麻痹，可能是由于神经根的椎间孔受压所致。
后路经椎弓根楔形截骨可使脊柱后凸得到显著矫正，更多是通过屈曲而非延长实现，且神经风险有限。然而，必须在截骨相邻节段广泛扩大椎管，以使硬脊膜能够向后扩张。
