【摘要】：目的觀察并分析后路經(jīng)椎弓根楔形截骨聯(lián)合椎弓根螺釘內(nèi)固定術(shù)矯正成人胸腰椎后凸畸形致矢狀位失衡的療效。方法收集2013.03-2015.03期間于大連醫(yī)科大學(xué)附屬二院脊柱外科診斷為胸、腰椎后凸患者的臨床資料和影像學(xué)資料進(jìn)行回顧性分析。所收集資料中,其中有8例患者行后路經(jīng)椎弓根楔形截骨聯(lián)合椎弓根螺釘內(nèi)固定術(shù)。所有患者術(shù)前、術(shù)后采集影像學(xué)資料(X線),根據(jù)X線測(cè)量TK、LL、PI、PT以及SVA五項(xiàng)相關(guān)矢狀位平衡的指標(biāo);Cobb角度;改良JOA評(píng)分;ASIA神經(jīng)功能分級(jí);VAS疼痛評(píng)分;術(shù)后患者矯形后的外觀、日�；顒�(dòng)改善情況以及并發(fā)癥發(fā)生情況。采用電話或門診等方式對(duì)患者進(jìn)行術(shù)后隨訪,平均隨訪時(shí)間4.8±2.7個(gè)月(2-7個(gè)月)。結(jié)果所收集的8例患者手術(shù)均順利完成。經(jīng)統(tǒng)計(jì)手術(shù)時(shí)間2.5-5h,平均3.5h;術(shù)中出血量600-2500ml,平均1600ml,均采用自體血回輸裝置。8例患者術(shù)后無(wú)死亡、癱瘓以及感染發(fā)生。術(shù)后患者腰背部疼痛、疲憊癥狀明顯緩解、甚至消失,患者表示對(duì)矯形后的外觀滿意,極大提高了生活質(zhì)量。術(shù)前、術(shù)后相比TK角變化不明顯,LL取得了理想的矯正,LL基本波動(dòng)在PI±9°,PT值取得了理想的矯正,平均16.5°。SVA均由術(shù)前的矢狀位失衡狀態(tài)(x=7.5cm)矯正到矢狀位平衡狀態(tài)(x=4.2cm)。8例患者術(shù)后Cobb角度得到明顯矯正,平均矯正32.00±9.51度。隨訪患者的改良JOA評(píng)分、VAS評(píng)分與術(shù)前相比明顯降低,而ASIA神經(jīng)功能分級(jí)與術(shù)前相比則明顯升高�；颊叱C形后的外觀及日常活動(dòng)與術(shù)前相比有明顯改善,達(dá)到預(yù)期的滿意效果,而且術(shù)后并發(fā)癥發(fā)生率較低。結(jié)論后路經(jīng)椎弓根楔形截骨聯(lián)合椎弓根螺釘內(nèi)固定術(shù),手術(shù)安全,手術(shù)時(shí)間較短,出血量相對(duì)少,術(shù)后并發(fā)癥發(fā)生率較低,矯形后外觀滿意,日常活動(dòng)得到明顯改善,是一種安全性較高、療效可靠的矯治成人胸腰椎后凸畸形致矢狀位失衡的手術(shù)方式。
[Abstract]:Objective to observe and analyze the effect of posterior transpedicular wedge osteotomy combined with pedicle screw fixation on sagittal imbalance caused by thoracolumbar kyphosis in adults. Methods the clinical data and imaging data of patients with thoracolumbar kyphosis diagnosed by spinal surgery in the second affiliated Hospital of Dalian Medical University were collected and analyzed retrospectively. Among the data collected, 8 patients underwent posterior transpedicular wedge osteotomy combined with pedicle screw fixation. Preoperative and postoperative radiographic data were collected from all patients. According to the X-ray measurements of TK,LL,PI,PT and SVA five related sagittal balance indexes; Cobb angle; modified JOA score; ASIA grading; VAS pain score; Postoperative orthopedic appearance, improvement of daily activities and complications. The patients were followed up by telephone or outpatient, the average follow-up time was 4.8 鹵2.7 months (2-7 months). Results all the 8 patients were successfully operated. The operative time was 2.5 to 5 hours with an average of 3.5 hours, and the intraoperative blood loss was 600-2500ml, with an average of 1600ml. All the patients were treated with autologous blood transfusion device. There was no death, paralysis or infection in 8 patients after operation. Postoperative pain in the back of the waist, fatigue symptoms, or even disappear, the patient expressed satisfaction with the appearance of orthopedic, greatly improved the quality of life. Before and after operation, the change of TK angle was not obvious, LL got ideal correction, LL fluctuated basically in PI 鹵9 擄, and the value of PT got ideal correction. Mean 16.5 擄. SVA was corrected from sagittal imbalance (x=7.5cm) to sagittal balance (x=4.2cm). The angle of Cobb was significantly corrected in 8 patients after operation, with an average correction of 32.00 鹵9.51 degrees. The modified JOA score, VAS score and ASIA neurological function score were significantly lower than those before operation. The appearance and daily activities of the patients after orthopedic surgery were significantly improved compared with those before operation, and the expected satisfactory results were achieved, and the incidence of postoperative complications was lower. Conclusion posterior transpedicular wedge osteotomy combined with pedicle screw internal fixation is safe, shorter operation time, less bleeding, lower incidence of postoperative complications, satisfactory appearance after orthopedic surgery, and obvious improvement of daily activities. It is a safe and reliable surgical method for correction of sagittal imbalance caused by thoracolumbar kyphosis in adults.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 桑長(zhǎng)利;;腰椎后凸畸形的康復(fù)訓(xùn)練[J];中國(guó)康復(fù)醫(yī)學(xué)雜志;1986年04期

2 陳仲?gòu)?qiáng);;胸腰椎后凸畸形的后路矯形手術(shù)[J];脊柱外科雜志;2013年06期

3 李勝華;歐云生;;胸腰椎后凸畸形的后路截骨矯形術(shù)[J];創(chuàng)傷外科雜志;2013年03期

4 邱勇;;對(duì)“雙椎體截骨術(shù)矯正強(qiáng)直性脊柱炎重度胸腰椎后凸畸形”一文的看法[J];中國(guó)脊柱脊髓雜志;2014年04期

5 陳亮元;曹奇;楊鐵軍;唐國(guó)軍;陳小明;;老年陳舊性結(jié)核性胸腰椎后凸畸形伴截癱的外科治療[J];中國(guó)矯形外科雜志;2010年09期

6 徐榮明;于亮;;重視老年人退變性腰椎后凸畸形的診斷與治療[J];現(xiàn)代實(shí)用醫(yī)學(xué);2013年05期

7 趙黎,李明全,馬真勝,杜俊杰,王海強(qiáng);先天性腰椎后凸畸形的因特網(wǎng)病例討論(Ⅱ)[J];中國(guó)骨傷;2002年07期

8 劉勇;高浩;楊紅梅;趙春成;羅卓荊;陳長(zhǎng)春;李文龍;;經(jīng)椎弓根椎體截骨內(nèi)固定治療陳舊性胸腰椎后凸畸形[J];中國(guó)矯形外科雜志;2007年10期

9 王翔奕;譚倫;;胸腰椎后凸畸形經(jīng)后路截骨矯形術(shù)的進(jìn)展[J];中國(guó)矯形外科雜志;2012年17期

10 盧旭華,陳德玉,袁文,徐建偉,郭永飛,何志敏,趙定麟;經(jīng)椎弓根椎體截骨技術(shù)在腰椎后凸畸形矯正中的應(yīng)用[J];中國(guó)矯形外科雜志;2005年19期

相關(guān)會(huì)議論文 前7條

1 滕曉;張招波;朱孟勇;王勇;朱賢平;;經(jīng)椎弓根椎體截骨治療胸腰椎后凸畸形的療效觀察[A];2007年浙江省醫(yī)學(xué)會(huì)骨科學(xué)學(xué)術(shù)會(huì)議暨浙江省抗癌協(xié)會(huì)骨軟腫瘤學(xué)術(shù)會(huì)議論文匯編[C];2007年

2 洪正華;陳海嘯;王章富;陳偉富;張傳毅;許曉光;;經(jīng)頂椎椎弓根開(kāi)合式截骨治療胸腰椎后凸畸形[A];浙江省醫(yī)學(xué)會(huì)骨科學(xué)分會(huì)30年慶典暨2011年浙江省骨科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2011年

3 盧旭華;陳德玉;袁文;徐建偉;郭永飛;何志敏;趙定麟;;經(jīng)椎弓根椎體截骨技術(shù)在腰椎后凸畸形矯正中的應(yīng)用[A];第四屆全軍腰腿痛學(xué)術(shù)研討會(huì)、第五屆全國(guó)肢殘康復(fù)護(hù)理研討會(huì)論文選編[C];2005年

4 陳中;樓險(xiǎn)峰;郭方;杜峻華;封志云;;胸腰椎后凸畸形后路360°截骨矯形病例報(bào)告[A];2012年浙江省骨科學(xué)術(shù)年會(huì)論文集[C];2012年

5 何清義;許建中;周強(qiáng);代飛;張勁松;;經(jīng)椎弓根閉合楔形截骨術(shù)矯正胸腰椎后凸畸形[A];第七屆全國(guó)創(chuàng)傷學(xué)術(shù)會(huì)議暨2009海峽兩岸創(chuàng)傷醫(yī)學(xué)論壇論文匯編[C];2009年

6 陳春;李江龍;江深河;劉福堯;劉繼波;夏玉萍;顏晶晶;周鵬;許明友;謝大偉;田慧中;;胸腰椎后凸畸形脊柱次全截骨矯形術(shù)的臨床應(yīng)用[A];2006年貴州省醫(yī)學(xué)會(huì)骨科學(xué)分會(huì)學(xué)術(shù)年會(huì)論文匯編[C];2006年

7 阮永平;胡勇;何賢峰;徐榮明;馬維虎;劉觀焱;顧勇杰;;經(jīng)后路頂椎椎弓根全椎體截骨矯正胸腰椎后凸畸形[A];2009年浙江省骨科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2009年

相關(guān)重要報(bào)紙文章 前1條

1 北京大學(xué)第三醫(yī)院骨科主任 劉忠軍;破解脊柱手術(shù)難題[N];健康報(bào);2008年

相關(guān)碩士學(xué)位論文 前2條

1 胡俊;強(qiáng)直性脊柱炎患者不同部位骨密度精確性比較及臨床意義[D];南京大學(xué);2014年

2 于青;后路經(jīng)椎弓根楔形截骨聯(lián)合椎弓根螺釘內(nèi)固定術(shù)矯正成人胸腰椎后凸畸形致矢狀位失衡的療效觀察[D];大連醫(yī)科大學(xué);2015年

，

本文編號(hào)：2367115