| 郭健峰,吴巍,方忠,等.椎体前移技术：胸腰椎后凸畸形矫形的新方法及其初步临床研究.骨科,2026,17(3): 201-207. |
| 椎体前移技术：胸腰椎后凸畸形矫形的新方法及其初步临床研究 |
| Wedge vertebral forward-shifting technique: A novel approach for correcting thoracolumbar kyphosis and its preliminary clinical research |
| 投稿时间：2026-01-06 |
| DOI：10.3969/j.issn.1674-8573.2026.03.001 |
| 中文关键词: 胸腰椎 后凸畸形 截骨技术 椎体前移技术 |
| 英文关键词: Thoracolumbar Kyphotic deformity Osteotomy Wedge vertebral forward-shifting technique |
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| 中文摘要: |
| 目的 探讨椎体前移技术在胸腰椎后凸畸形矫形术中的临床有效性及安全性。方法 回顾性分析2014年8月至2023年1月期间接受椎体前移技术矫形治疗的24例胸腰段后凸畸形患者的临床资料，其中男14例，女10例；年龄为（42.8±15.4）岁（15~68岁）；包括先天性后凸畸形8例，创伤性后凸畸形16例。采用疼痛视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）及美国脊柱损伤协会（American Spinal Injury Association，ASIA）脊髓损伤分级评估患者的临床疗效；比较患者手术前后的脊柱影像学参数，并记录手术时间、术中出血量、术后住院时间、围手术期并发症及植骨融合情况。结果 手术时间（240.5±42.4） min，术中出血量（716.7±220.5） mL，术后住院时间（8.3±2.1） d，随访时间（31.1±9.2）个月。术后及末次随访时腰背部VAS评分及ODI较术前显著降低（P＜0.05）。13例术前神经功能障碍患者中，有10例（76.9%）神经功能得到改善。24例患者骨盆入射角（PI）为44.0°±5.4°，椎体前移距离为（6.8±2.3） mm。术前局部后凸角（LK）为44.1°±6.7°，末次随访时为8.6°±4.1°，较术后即刻矫形丢失1.8°，局部后凸矫形率为80.5%。术后腰椎前凸角（LL）及胸椎后凸角（TK）均较术前显著增加（P＜0.05），但术前术后的矢状面垂直轴（SVA）无显著差异（P＞0.05）。围手术期并发症主要包括2例硬膜损伤，3例一过性根性症状，1例伤口愈合不良，无神经功能恶化、无内固定相关并发症及假关节形成。结论 椎体前移技术可为部分胸腰椎后凸畸形矫正提供新的矫形策略，可安全有效矫正局部胸腰段后凸畸形，同时达到神经减压目的；且操作简单，创伤小，围手术期及长期并发症较少。 |
| 英文摘要: |
| Objective To evaluate the clinical efficacy and safety of the wedge vertebra forward-shifting technique in the correction of thoracolumbar kyphosis. Methods A retrospective analysis was conducted on 24 patients with thoracolumbar kyphosis who were treated with the wedge vertebra forward-shifting technique between August 2014 and January 2023. The cohort consisted of 14 males and 10 females, with a mean age of 42.8±15.4 years (15-68 years). Etiologies included congenital kyphosis (8 cases) and post-traumatic kyphosis (16 cases). Clinical outcomes were evaluated using the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the American Spinal Injury Association (ASIA). Pre- and postoperative spinal radiological parameters were compared. Additionally, operative time, estimated blood loss, postoperative hospital stay, perioperative complications, and bone fusion status were recorded. Results The mean operative time was 240.5±42.4 min, intraoperative blood loss was 716.7±220.5 mL, length of postoperative hospital stay was 8.3±2.1 days, and follow-up duration was 31.1±9.2 months. At postoperation and the last follow-up, the back pain VAS and ODI scores were significantly decreased compared with preoperative baselines (P＜0.05). Ten of the 13 patients (76.9%) with preoperative neurological deficits got neurological improvement. The mean pelvic incidence (PI) of the cohort was 44.0°±5.4°, and the vertebral translation distance was 6.8±2.3 mm. The local kyphosis (LK) significantly improved from 44.1°±6.7° preoperatively to 8.6°±4.1° at the last follow-up, yielding a correction rate of 80.5%, with a minor correction loss of 1.8° compared to the immediate postoperative angle. Both postoperative lumbar lordosis (LL) and thoracic kyphosis (TK) were significantly increased (P＜0.05), whereas the sagittal vertical axis (SVA) showed no significant difference before and after surgery (P＞0.05). Perioperative complications included 2 cases of dural tears, 3 cases of transient radicular symptoms, and 1 case of wound healing delay. No neurological deterioration, implant-related complications, or pseudarthrosis was observed. Conclusion The wedge vertebra forward-shifting technique provides a novel strategy for the correction of thoracolumbar kyphotic deformities. It can safely and effectively correct local thoracolumbar kyphosis while simultaneously achieving neural decompression. Furthermore, the procedure is technically straight forward, involves minimal surgical trauma, and is associated with fewer perioperative and long-term complications. |
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