CAJ | 학술논문

目的探讨经椎弓根"蛋壳"技术单椎体截骨治疗脊柱角状后凸畸形的可行性及疗效.方法对2005年8月至2008年9月应用椎弓根钉-棒系统一期后路经椎弓根"蛋壳"技术单椎体楔形截骨治疗17例脊柱角状后凸畸形患者进行回顾性研究,男11例,女6例;年龄26～58岁,平均42.3岁;其中创伤后胸腰椎后n畸形14例,陈旧性结核脊柱后凸畸形3例;后凸Cobb角32°～63°,平均45.1°±17.3°;矢状面平衡距离12.5～19.0 cm,平均(16.5±2.8)cm.8例患者术前有神经系统症状,Frankel分级:c级3例,D级5例.结果手术时间160～230 min(平均185 min),术中出血800～1450 mL(平均1150 mL),术后患者未出现神经系统症状加重,无伤口感染,所有患者腰背部疼痛、外观及后凸畸形均明显改善.所有患者均得到随访,平均随访时间18个月(8～33个月).8例术后神经功能均恢复正常.患者术后及末次随访时脊柱后凸Cobb角(9.2°±7.9°)及矢状面平衡[(7.5±2.4)cm]与术前比较有明显改善,差异有统计学意义(P<0.05),末次随访时患者矫正无明显丢失.结论一期后路经椎弓根"蛋壳"技术单椎体截骨是治疗轻中度脊柱角状后凸畸形安全有效的方法.该技术矫正后凸畸形效果满意,腰背部疼痛及神经功能改善明显,可使脊髓和神经根充分减压(360°减压),同时最大程度地避免了脊髓、神经根和椎体侧前方血管的损伤.
목적 탐토경추궁근"단각"기술단추체절골치료척주각상후철기형적가행성급료효.방법 대2005년8월지2008년9월응용추궁근정-봉계통일기후로경추궁근"단각"기술단추체설형절골치료17례척주각상후철기형환자진행회고성연구,남11례,녀6례;년령26～58세,평균42.3세;기중창상후흉요추후n기형14례,진구성결핵척주후철기형3례;후철Cobb각32°～63°,평균45.1°±17.3°;시상면평형거리12.5～19.0 cm,평균(16.5±2.8)cm.8례환자술전유신경계통증상,Frankel분급:c급3례,D급5례.결과 수술시간160～230 min(평균185 min),술중출혈800～1450 mL(평균1150 mL),술후환자미출현신경계통증상가중,무상구감염,소유환자요배부동통、외관급후철기형균명현개선.소유환자균득도수방,평균수방시간18개월(8～33개월).8례술후신경공능균회복정상.환자술후급말차수방시척주후철Cobb각(9.2°±7.9°)급시상면평형[(7.5±2.4)cm]여술전비교유명현개선,차이유통계학의의(P<0.05),말차수방시환자교정무명현주실.결론 일기후로경추궁근"단각"기술단추체절골시치료경중도척주각상후철기형안전유효적방법.해기술교정후철기형효과만의,요배부동통급신경공능개선명현,가사척수화신경근충분감압(360°감압),동시최대정도지피면료척수、신경근화추체측전방혈관적손상.
Objective To investigate the curative effect of one stage trails-pedicular posterior "Eggshell"osteotomy of single-level vertebra for the correction of angular spinal kyphosis. Methods From August 2005 to September 2008,17 cases(a mean age of 42.3 years old)of angular spinal kyphosis with an average Cobb angle of 45°were admitted to our department.All patients underwent one stage transpedicular posterior"Eggshell"osteotomy of single-level vertebra and fixation with pedicle screws.Results The average operating time wag 185 min(range,160 to 230 min).The average blood loss was 1150 mL(range,800 to 1450 mL).No neurologic complications or post-operative infections Were noted.Before operation.8 patients were found to have neurological deficits,including Frankei grade C in 3 patients and Din 5 patients.After operation,the grades were all improved to Frankel E.The spinal sagittal Cobb angle of the vertebral osteotomy segment was corrected from the preoperative kyphosis of 45.1°±17.3°to the postoperative kyphosis of 9.2°±7.9°.with an average correction rate of 80%.The sagittal balance distance was corrected from preoperative(16.5±2.8)cm to postoperative(7.5±2.4)cm. Conclusions One stage transpedicular posterior"Eggshell"osteotomy of single-level vertebra may be a safe and effective technique for the treatment of angular spinal kyphosis,because it can fully decompress the neurological structures and correct the kyphosis deformity.It may especially help avoid injuries to the spinal cord,nerve roots and blood Vessels.