Objective To observe the results of posterior osteotomy and correction in the surgical treatment of old tuberculous kyphosis.Methods From June 2004 to December 2008,31 cases of old tuberculous kyphosis with posterior osteotomy and correction technique were treated.There were 12 cases of male and 19 cases of female.The average age was 33.4 years.Pedicle subtraction osteotomy or vertebral column resection were applied in surgery.The kyphosis angle,lumbar lordosis angle and sagittal balance condition of the spine were measured before and after surgery,as well as follow-up.The Frankel grading system for neurological function of lower extremities,the Oswestry disability index (ODI) for life quality,and patient satisfactory index (PSI) for satisfaction of surgery were applied before surgery and at follow-up.Results The average kyphosis angle was 94° ±27°,the average lumbar lordosis angle was 71° ±20°,and the average sagittal C7 plumb line was ( - 15 ± 44) mm away from the balance region before surgery.The average kyphosis angle decreased to 26° ± 11° in one week after surgery,with an improvement rate of 71.4％.The average follow-up time was 22.5 months.The average kyphosis angle was 28° ± 12° at the final follow-up,with an improvement rate of 70.0％.The average lumbar lordosis angle was 46° ± 11°,with an improvement rate of 35.1％.The postoperative kyphosis angle and lumbar lordosis angle were significantly different with that of pre-operation (for kyphosis angle: t =16.3,P ＜0.05 ； for lumbar lordosis angle: t =8.1,P ＜0.05).The average sagittal C7 plumb line was( -4 ±22)mm away from the balance region at the final follow-up,with an improvement rate of 73.4％.The Frankel grading were E in 13 cases,D in 13 cases,and C in 5 cases before surgery,and were E in 20 cases,D in 8 cases,and C in 3 cases at the final follow-up.The average ODI was 13 ± 12 before surgery,and was 7 ±8 at the final follow-up,with an improvement rate of 45.2％.The PSI results showed a satisfied rate of 90.3％.Conclusion Good results can be achieved by applying proper posterior osteotomy and correction technique according to the severity of old tuberculous kyphosis.%目的 观察后路截骨矫形手术治疗陈旧结核性脊柱后凸的临床效果.方法 自2004年6月至2008年12月采用后路截骨矫形固定手术治疗31例陈旧结核性脊柱后凸患者,其中男性12例,女性19例,年龄13 ～56岁,平均33.4岁.手术方式包括后路经后凸顶点(椎弓根或椎间隙)截骨+闭合矫形或前方撑开-后方闭合矫形和后凸融合节段切除截骨,双轴旋转矫形和前柱重建.观察手术前后的后凸角度、腰椎前凸角和脊柱矢状位的平衡状况.同时于术前和随访时应用Frankel分级评定下肢神经功能,应用Oswestry功能障碍指数(ODI)评价患者生活质量.用患者满意指数(PSI)评价手术满意度.结果 术前平均后凸角度为94°±27°,平均腰椎前凸角为71°±20°,脊柱矢状位力线平均为(-15 ±44)mm.术后1周平均后凸角度改善为26°±11°,平均改善率为71.4％.术后平均随访22.5个月,末次随访时平均后凸角度为28°±12°,平均改善率为70.0％；平均腰椎前凸角为46°±11°,平均改善率为35.1％.术后后凸角度和腰椎前凸角与术前相比,其差异均有统计学意义(t=16.3和8.1,P＜0.05).脊柱矢状位力线平均为(-4 ±22)mm,平均改善率为73.4％.术前患者Frankel分级为E级13例,D级13例,C级5例；末次随访时E级增加至20例,D级8例,C级3例.术前ODI评分平均为(13±12)分,末次随访时改善为(7±8)分,平均改善率为45.2％.PSI显示总满意率为90.3％.结论 根据陈旧结核性脊柱后凸畸形的严重程度选择合适的截骨矫形方式,可以获得较好的手术效果.
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