CAJ | 학술논문

目的探讨Ponté截骨联合椎间隙颗粒骨打压植骨矫正陈旧性胸腰椎骨折后凸畸形的有效性与安全性.方法 2010年6月至2013年3月,手术治疗陈旧性胸腰椎骨折后凸畸形13例,男7例,女6例;年龄32～78岁,平均54.5岁;伤椎为Tn1例、T124例、L15例、L2 3例.均存在进行性加重的腰背部疼痛、后凸畸形及不等程度的神经功能障碍.采用Ponté截骨,椎间隙松解并完整保留前纵韧带及尽量保留骨性终板,椎间隙内颗粒骨打压植骨实现初步矫形,再利用矫形棒进行二次矫形矫正后凸畸形.采用后凸Cobb角变化、植骨融合情况、视觉模拟评分(visual analog scale,VAS)、Oswestry 功能障碍指数(Oswestry disability index,ODI)、ASIA神经功能分级评价疗效.结果均获得9～36个月的随访,平均(20.0±9.1)个月.随访12个月时均获得骨性融合.脊柱局部后凸角由术前平均42.2°(26°～54°)改善为术后平均7.1°(-7°～13°),平均矫正率为83.2％.骶骨后上角至脊柱矢状轴线的距离由术前平均2.91 cm(-3.0～7.8 cm)减小至术后1.35 cm(-0.5～3.8cm),胸椎后凸角、腰椎前凸角、骶骨水平角均有不等程度地改善.VAS评分由术前平均(6.38±0.87)分降低至末次随访时平均(2.23±0.83)分,ODI评分由术前平均(55.0±12.1)分降低至末次随访时平均(20.6±7.3)分,差异均有统计学意义.ASIA分级术前C级6例(术后D级2例、E级4例)、D级7例均为E级.结论应用Ponté截骨联合椎间隙颗粒骨打压植骨治疗陈旧性胸腰椎骨折后凸畸形具有矫正角度大、融合率高、手术创伤小、并发症少等优势.
목적 탐토Ponté절골연합추간극과립골타압식골교정진구성흉요추골절후철기형적유효성여안전성.방법 2010년6월지2013년3월,수술치료진구성흉요추골절후철기형13례,남7례,녀6례;년령32～78세,평균54.5세;상추위Tn1례、T124례、L15례、L2 3례.균존재진행성가중적요배부동통、후철기형급불등정도적신경공능장애.채용Ponté절골,추간극송해병완정보류전종인대급진량보류골성종판,추간극내과립골타압식골실현초보교형,재이용교형봉진행이차교형교정후철기형.채용후철Cobb각변화、식골융합정황、시각모의평분(visual analog scale,VAS)、Oswestry 공능장애지수(Oswestry disability index,ODI)、ASIA신경공능분급평개료효.결과 균획득9～36개월적수방,평균(20.0±9.1)개월.수방12개월시균획득골성융합.척주국부후철각유술전평균42.2°(26°～54°)개선위술후평균7.1°(-7°～13°),평균교정솔위83.2％.저골후상각지척주시상축선적거리유술전평균2.91 cm(-3.0～7.8 cm)감소지술후1.35 cm(-0.5～3.8cm),흉추후철각、요추전철각、저골수평각균유불등정도지개선.VAS평분유술전평균(6.38±0.87)분강저지말차수방시평균(2.23±0.83)분,ODI평분유술전평균(55.0±12.1)분강저지말차수방시평균(20.6±7.3)분,차이균유통계학의의.ASIA분급술전C급6례(술후D급2례、E급4례)、D급7례균위E급.결론 응용Ponté절골연합추간극과립골타압식골치료진구성흉요추골절후철기형구유교정각도대、융합솔고、수술창상소、병발증소등우세.
Objective To describe Ponté osteotomy and interbody fusion with impacted morsellized bone graft and to investigate the safety and efficacy for the correction of post-traumatic kyphosis (PTK) in the thoracolumbar spine.Methods From June 2010 to March 2013,13 patients with PTK in the thoracolumbar spine were treated through Ponté osteotomy and interbody fusion with impacted morsellized bone graft.There were 7 males and 6 females,aged from 32 to 78 years,average 54.5 years.The apex level of kyphosis was T11 in 1,T12 in 4,L1 in 5 and L2 in 3.There was failure of first surgery in seven patients,and inappropriate conservative treatment in six,that all suffered from pain,progressive deformity,and deteriorating neurologic status.During the operation,the intervertebral space was loosened radically through Ponté osteotomy and discectomy,and the kyphosis was firstly corrected using the morcellized impacted graft technique.Then the kyphosis was corrected using the correction rod technique with the hinge of the morcellized impacted graft.Radiographical assessments included localized kyphosis,thoracic kyphosis,lumbar lordosis,sacral tilt angle,sagittal vertical axis,bony fusion and the relative height of the interbody fusion vertebra.Visual analogue scale (VAS),Oswestry disability index (ODI) and ASIA were evaluated before and after surgery,and the operative duration,blood loss were recorded.Results All patients were successfully followed up for an average time of (20.0±9.1) months.Bony fusion was achieved in all patients at 12 months follow-up.Localized kyphosis was reduced from an average of 42.2° (26° to 54°) to 7.1° (-7° to 13°) with an correction rate of 83.2％ on average.Sagittal alignment from T1 to the sacrum became more physiologic from 2.91cm (-3.0 to 7.8 cm) to 1.35cm (-0.5 to 3.8 cm).Thoracic kyphosis,lumbar lordosis and sacral tilt angle all improved at followup.The average VAS score was 6.38±0.87 (range,5 to 8) before operation and 2.23±0.83 (range,1 to 4) at final follow-up.The average ODI score was 55.0± 12.1 (range,39 to 72) before operation and 20.6±7.3 (range,11 to 34) at final follow-up.Neurological function improved from C to D in two patients,from C to E in four patients,and from D to E in seven patients.Conclusion Application of Ponté osteotomy and interbody fusion with impacted morsellized bone graft for the correction of PTK in the thoracolumbar spine has several advantages:large angle correction,high fusion rate,mini-invasion,and little nerve complications.