Wu S S, Hwa S Y, Lin L C, Pai W M, Chen P Q, Au M K
Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan ROC.
Spine (Phila Pa 1976). 1996 Oct 1;21(19):2260-6; discussion 2267. doi: 10.1097/00007632-199610010-00016.
Rigid post-traumatic kyphosis after fracture of the thoracolumbar and lumbar spine represents a failure of initial management of the injury. Kyphosis moves the center of gravity anterior. The kyphosis and instability may result in pain, deformity, and increased neurologic deficits. Management for symptomatic post-traumatic kyphosis always has presented a challenge to orthopedic surgeons.
To evaluate the surgical results of one stage posterior correction for rigid symptomatic post-traumatic kyphosis of the thoracolumbar and lumbar spine.
The management for post-traumatic kyphosis remains controversial. Anterior, posterior, or combined anterior and posterior procedures have been advocated by different authors and show various degrees of success.
One vertebra immediately above and below the level of the deformity was instrumented posteriorly by a transpedicular system (internal fixator AO). Posterior decompression was performed by excision of the spinal process and bilateral laminectomy. With the deformed vertebra through the pedicle, the vertebral body carefully is removed around the pedicle level, approximating a wedge shape. The extent to which the deformed vertebral body should be removed is determined by the attempted correction. Correction of the deformity is achieved by manipulation of the operating table and compression of the adjacent Schanz screws above and below the lesion.
Thirteen patients with post-traumatic kyphosis with symptoms of fatigue and pain caused by slow progression of kyphotic deformities received posterior decompression, correction, and stabilization as a definitive treatment. The precorrection kyphosis ranged from 30-60 degrees, with a mean of 40 degrees +/- 10.8 degrees. After correction, kyphosis was reduced to an average of 1.5 degrees +/- 3.8 degrees, with a range from -5 degrees to 5 degrees. The average angle of correction was 38.8 degrees +/- 10.4 degrees, with a range from 25 degrees to 60 degrees. Significant difference was found between pre- and post-operative kyphosis measures (P < 0.001). The follow-up period for all patients was 2 years, and the average kyphosis angle measured at the moment was 3.8 degrees +/- 3 degrees with a range from -3 degrees to 8 degrees. Substantial overall improvement was achieved in the 13 patients.
This method provides single-stage posterior decompression, correction, and stabilization on as definitive management for post traumatic kyphosis of the thoracolumbar and lumbar spine.
胸腰椎骨折后出现的僵硬性创伤后驼背代表了损伤初始治疗的失败。驼背使重心向前移动。驼背和不稳定可能导致疼痛、畸形以及神经功能缺损增加。有症状的创伤后驼背的治疗一直是骨科医生面临的挑战。
评估一期后路矫正治疗胸腰椎僵硬性有症状创伤后驼背的手术效果。
创伤后驼背的治疗仍存在争议。不同作者主张采用前路、后路或前后联合手术，且显示出不同程度的成功。
在畸形节段上下紧邻的一个椎体上经椎弓根系统（AO内固定器）进行后路固定。通过切除棘突和双侧椎板进行后路减压。经椎弓根进入变形椎体，在椎弓根水平小心地将椎体周围骨质切除，近似楔形。切除变形椎体的范围由预期矫正程度决定。通过调整手术台以及对病变上下相邻的斯氏针进行加压来矫正畸形。
13例因驼背畸形缓慢进展而出现疲劳和疼痛症状的创伤后驼背患者接受了后路减压、矫正和固定作为最终治疗。矫正前驼背角度范围为30°至60°，平均为40°±10.8°。矫正后，驼背平均减小至1.5°±3.8°，范围为-5°至5°。平均矫正角度为38.8°±10.4°，范围为25°至60°。术前和术后驼背测量值之间存在显著差异（P<0.001）。所有患者的随访期为2年，此时测得的平均驼背角度为3.8°±3°，范围为-3°至8°。13例患者总体上有显著改善。
该方法提供了一期后路减压、矫正和固定，作为胸腰椎创伤后驼背的最终治疗方法。
