中文摘要：

目的探讨Pont6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T11 1例、T12 4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Pont6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（visualanalogscale，VAS）、Oswestry功能障碍指数（Oswestrydisabilityindex，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2．91cm（-3．0-7．8cm）减小至术后1．35cm（-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Ponte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。

英文摘要：

Objective To describe Pont6 osteotomy and interbody fusion with impacted morsellized bone graft and to in- vestigate 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 Ponte osteotomy and interbody fu- sion 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 T, in 1, T12 in 4, L1 in 5 and L2 in 3. There was failure of first surgery in seven patients, and inappropri- ate 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 Pont6 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 follow- up. The average VAS score was 6.38±0.87 （range, 5 to 8） before operation an