创伤后后凸

病因

创伤后引起的后凸常发生于胸腰椎或腰椎，这种后凸多见于神经损害严重的患者，如四肢麻痹或半身瘫痪（图1A）

图 1A

图 1B

创伤后后凸畸形发生于创伤后早期处理失败或未发现骨折，也会由手术操作不当所致，就像右侧的图片一样。

图 2A

图 2B

症状

后凸畸形会导致慢性伤残性疼痛，疼痛来源包括：

• 脊椎肌肉劳损
• 慢性炎症和进行性退变
• 来自脊髓或神经根前方的碰撞

体征

当前柱及所有后韧带出现紊乱时, 进行性后凸畸形会逐渐形成。半身瘫痪患者会因后凸畸形而引致坐姿平衡及皮肤的问题。

可供选择的治疗

后凸畸形的治疗目的是矫正畸形、稳定相关的脊椎、减轻疼痛和改善神经功能。

柔韧性好的后凸畸形可以行后路融合内固定治疗，僵硬的畸形则需要更为复杂的手术治疗。

参考文献

1. Atici T, A. U., Akesen B, Serifoglu R. (2004). "Results of surgical treatment for kyphotic deformity of the spine secondary to trauma or Scheuermann's disease." Acta Orthop Belg 70(4): 344-8.
2. Been HD, P. R., Ubags LH. (2004). "Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures." Eur Spine J 13(2): 101-7.
3. Jodoin A, G. P., Dupuis PR, Maurais G. (1989). "Surgical treatment of post-traumatic kyphosis: a report of 16 cases." Can J Surg. 32(1): 36-42.
4. Klockner C, H. A., Weber U. (2001). "Post-traumatic kyphosis of the truncal vertebrae." Orthopade. 30(12): 947-54.
5. Kostuik JP, M. H. (1989). "Anterior stabilization, instrumentation, and decompression for post-traumatic kyphosis." Spine. 14(4): 379-86.
6. Lazennec JY, N. N., Rousseau MA, Boyer P, Pascal-Mousselard H, Saillant G. (2006). "Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels." J Spinal Disord Tech. 19((7):): 487-94.
7. Vaccaro AR, S. J. (2001). "Post-traumatic spinal deformity." 26 24(S111-8).
8. Wawro W, B. N., Aebi M. (1992). "Technique of surgical correction of post-traumatic kyphosis." Unfallchirurg 95(1): 41-6.
9. Wenger M, B. M., Markwalder TM. (2005). "Post-traumatic cervical kyphosis with surgical correction complicated by temporary anterior spinal artery syndrome." J Clin Neurosci 12(2): 193-6.
10. Wu SS, H. S., Lin LC, Pai WM, Chen PQ, Au MK. (1996). "Management of rigid post-traumatic kyphosis." Spine. 21(19): 2260-7
11. Zhi., Z. W. K. Z. (2005). "Surgical correction of post-traumatic kyphosis of thoracolumbar spine." 43(4): 201-4.