| 后路个体化三柱截骨矫形治疗结核性脊柱角状后凸畸形 |
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投稿时间：2024-03-14
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| 作者 | Author | 单位 | Address | E-Mail |
| 丁江平 |
DING Jiang-ping |
巴州人民医院, 新疆 库尔勒 841000 |
Bazhou People's Hospital, Korla 841000, Xinjiang, China |
2969454466@qq.com |
| 盛伟斌 |
SHENG Wei-bin |
新疆医科大学第一附属医院, 新疆 乌鲁木齐 830001 |
The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, Xinjiang, China |
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| 王斌 |
WANG Bin |
巴州人民医院, 新疆 库尔勒 841000 |
Bazhou People's Hospital, Korla 841000, Xinjiang, China |
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| 唐国柱 |
TANG Guo-zhu |
巴州人民医院, 新疆 库尔勒 841000 |
Bazhou People's Hospital, Korla 841000, Xinjiang, China |
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| 李宗健 |
LI Zong-jian |
巴州人民医院, 新疆 库尔勒 841000 |
Bazhou People's Hospital, Korla 841000, Xinjiang, China |
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| 冯新文 |
FENG Xin-wen |
巴州人民医院, 新疆 库尔勒 841000 |
Bazhou People's Hospital, Korla 841000, Xinjiang, China |
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| 期刊信息：《中国骨伤》2024年，第37卷，第11期，第1069-1074页 |
| DOI：10.12200/j.issn.1003-0034.20230903 |
| 基金项目:新疆维吾尔自治区自然科学基金面上项目(编号:2022D01A03) |
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中文摘要:
目的: 探讨后路三柱截骨矫形术治疗重度结核性脊柱角状后凸畸形的疗效。
方法: 2006年1月至2019年1月应用后路三柱截骨矫形术治疗结核性脊柱重度角状后凸畸形患者33例,男24例,女9例;年龄15~62(40.6±23.3)岁;病程4~40(23.5±15.5)年;后凸畸形Cobb角(118.65±28.82)°。个体化应用后路经椎弓根椎体椎间盘截骨术(bone-disc-bone osteotomy,BDBO)、全椎体切除术(vertebral column resection,PVCR) 和多节段椎体截骨(posterior multilevel vertebral osteotomy,PMVO)矫正脊柱畸形。术前后采用疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI)、矢状面轴向垂直距离(sagittal vertical axis,SVA)、顶椎椎管矢状径、美国脊髓损伤学会(American Spinal Injury Association,ASIA)脊髓运动功能分级、畸形矫正率进行疗效评价。
结果: 33例患者术后获得随访,时间15~96(38.00±6.38)个月。后凸Cobb角末次随访(23.88±5.45)°,较术后12个月(20.40±9.13)°无明显丢失(P>0.05)。术后1年和末次随访SVA、VAS、ODI、ASIA脊髓运动功能评分较术前明显改善(P<0.01)。截骨端植骨融合时间(18.50±5.16)个月。术前15例有脊髓损伤者术后ASIA分级较术前至少提高2个级别,不同程度恢复日常生活及工作能力。术后脊髓损伤并发症3例。
结论: 后路三柱截骨矫形术是治疗脊柱结核角状后凸畸形最有效的方法,缜密的术前设计和个体化截骨术式施术,既可矫正畸形,又能对脊髓有效减压,减少神经并发症,促进脊髓功能恢复。 |
| 【关键词】脊柱结核 脊柱畸形 截骨术 并发症 |
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| Reposterior individualized three-column osteotomy for tuberculous spinal angular kyphosis deformity |
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ABSTRACT
Objective To investigate the efficacy of posterior three-columns osteotomy in the treatment of severe tuberculous angular kyphosis.
Methods Total of 33 patients with severe tuberculous angular kyphosis were treated with posterior three-columns osteotomy from January 2006 to January 2019 including 24 males and 9 females with an average age of (40.6±23.3) years old ranging from 15 to 62 years old and an average disease duration of (23.5±15.5) years ranging from 4 to 40 years. The Cobb's angle of kyphosis was (118.65±28.82)°. Interradicular bone-disc-bone osteotomy(BDBO),posterior-only vertebral column resection (PVCR) and posterior multilevel vertebral osteotomy (PMVO) were performed to correct spinal deformity individually. The visual analogue scale (VAS),Oswestry disability index (ODI),sagittal vertical axis (SVA),ASIA spinal cord functional classification and motor function score,and deformity correction rate were measured and statistically analyzed before,after and at the final follow-up.
Results Total of 33 patients were followed up from 15 to 96 months with an average of (38.00±6.38) months. The last follow-up of kyphosis Cobb angle (23.88±5.45)° showed no significant loss from postoperative 12 months (20.40±9.13)°,P>0.05. The SVA,VAS,ODI and ASIA spinal cord functional classification and motor function score were significantly improved at 1 year and last follow-up after operation(P<0.01). The fusion time of the osteotomy site was (18.50±5.16) months. The ASIA classification of 15 patients with spinal cord injury were improved by at least 2 grades after operation,and their daily life and work ability were various levels of restored. Postoperative complications of spinal cord injury occurred in 3 cases.
Conclusion Posterior three-columns osteotomy is the most effective method for the treatment of angular kyphosis of spinal tuberculosis.Careful preoperative design and individualized osteotomy can not only correct the deformity,but also a successful decompression to the spinal cord and promote the recovery of spinal cord function. |
| KEY WORDS Spinal tuberculosis Spinal deformity Osteotomy Complication |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 丁江平,盛伟斌,王斌,唐国柱,李宗健,冯新文.后路个体化三柱截骨矫形治疗结核性脊柱角状后凸畸形[J].中国骨伤,2024,37(11):1069~1074 |
| 英文格式: | DING Jiang-ping,SHENG Wei-bin,WANG Bin,TANG Guo-zhu,LI Zong-jian,FENG Xin-wen.Reposterior individualized three-column osteotomy for tuberculous spinal angular kyphosis deformity[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(11):1069~1074 |
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