CAJ | 학술논문

目的探讨经椎弓根精确截骨治疗脊柱胸腰段后凸畸形的临床疗效.方法 2007年6月至2010年10月,脊柱胸腰段后凸畸形18例,男13例,女5例;年龄32～67岁,平均(48.6±15.4)岁.后凸顶椎T12 5例,L1 9例,L2 4例.陈旧性骨折11例、陈旧性结核4例、半椎体畸形3例.均采用“C”型臂X线透视引导下经椎弓根精确截骨.比较手术前后矢状面Cobb角、Frankel脊髓损伤分级、腰痛视觉模拟评分、Oswestry功能障碍指数.结果手术时间(247.0±29.3)min,出血量(708.5±34.5) ml.所有患者均获得随访,随访时间1.0～4.5年,平均2.8年.截骨面均获得骨性融合;矢状面Cobb角由42.3°±5.7°矫正至术后3个月2.2°±1.9°,末次随访2.7°±2.1 °;腰痛视觉模拟评分由(8.5±1.0)分降低至术后3个月(2.1±0.7)分,末次随访(1.9±0.6)分.Oswestry功能障碍指数由72.8％±8.3％降至术后3个月21.6％±9.2％,末次随访19.3％±8.6％;术后3个月Frankel脊髓损伤分级改善1级7例、2级2例,末次随访改善1级5例、2级4例.2例术后出现一过性神经症状,其余病例均无明显神经损害、椎弓根钉松动、断裂及假关节形成.结论经椎弓根精确截骨治疗胸腰段后凸畸形矫形准确,截骨面融合率高,并发症少.
목적 탐토경추궁근정학절골치료척주흉요단후철기형적림상료효.방법 2007년6월지2010년10월,척주흉요단후철기형18례,남13례,녀5례;년령32～67세,평균(48.6±15.4)세.후철정추T12 5례,L1 9례,L2 4례.진구성골절11례、진구성결핵4례、반추체기형3례.균채용“C”형비X선투시인도하경추궁근정학절골.비교수술전후시상면Cobb각、Frankel척수손상분급、요통시각모의평분、Oswestry공능장애지수.결과 수술시간(247.0±29.3)min,출혈량(708.5±34.5) ml.소유환자균획득수방,수방시간1.0～4.5년,평균2.8년.절골면균획득골성융합;시상면Cobb각유42.3°±5.7°교정지술후3개월2.2°±1.9°,말차수방2.7°±2.1 °;요통시각모의평분유(8.5±1.0)분강저지술후3개월(2.1±0.7)분,말차수방(1.9±0.6)분.Oswestry공능장애지수유72.8％±8.3％강지술후3개월21.6％±9.2％,말차수방19.3％±8.6％;술후3개월Frankel척수손상분급개선1급7례、2급2례,말차수방개선1급5례、2급4례.2례술후출현일과성신경증상,기여병례균무명현신경손해、추궁근정송동、단렬급가관절형성.결론 경추궁근정학절골치료흉요단후철기형교형준학,절골면융합솔고,병발증소.
Objective To evaluate clinical effect of accurate pedicle subtraction osteotomy (PSO) using osteotomes in the treatment of thoracolumbar kyphosis (TLK).Methods From June 2007 to October 2010,18 patients with TLK underwent accurate PSO using osteotomes under X-ray fluoroscopy,including 13 males and 5 females,with an average age of 48.6 years.The primary causes of TLK included old fracture (11cases),chronic tuberculosis (4 cases) and hemivertebra (3 cases).Deformity apex occurred at T12 (5 cases),L1 (9 cases),and L2 (4 cases).Radiological assessment for sagittal balance was performed by measuring Cobb angle.The Frankel grade,visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate pre-and post-operative neurological status,back pain and function.Results The mean operative time,mean blood loss and mean postoperative drainage volume were 247.0±29.3 minutes,708.5±34.5 ml and 337.3±74.6 ml,respectively.All patients were followed up for 1 to 4.5 years (average,2.8 years).Solid fusion was achieved in all patients.Cobb angle was corrected from preoperative 42.3°±5.7° to 2.2°±1.9° three months postoperatively and 2.7°±2.1 ° at final follow-up.VAS and ODI scores decreased from preoperative 8.5±1.0 and 72.8％±8.3％ to 2.1±0.7 and 21.6％±9.2％ three months postoperatively,and 1.9±0.6 and 19.3％±8.6％ at final follow-up,respectively.With regard to Frankel grade,a 1-grade and 2-grade improvement was observed in 7 cases and 2 cases 3 months postoperatively,respectively.At final follow-up,a 1-grade and 2-grade improvement was observed in 5 cases and 4 cases,respectively.Two patients had transient neurological symptoms postoperatively,which recovered after drug treatment for 2 weeks.No other complications occurred.Conclusion It is safe and effective to correct TLK through accurate PSO using osteotomes,which has some advantages,such as less blood loss,higher fusion rate and fewer complications.