后方单侧截骨入路椎体大部分切除固定矫形术治疗陈旧性胸腰段椎体压缩骨折伴后凸畸形

Posterior unilateral vertebral column resection for old thoracolumbar compressive fracture accompanied with kyphotic deformity

目的 探讨后方单侧截骨入路椎体大部分切除固定矫形术（PUVCR）治疗陈旧性胸腰段椎体压缩骨折伴后凸畸形的疗效. 方法 自2009年2月至2013年1月共49例陈旧性胸腰段椎体压缩骨折伴后凸畸形患者纳入本项研究,根据治疗方式不同分为PUVCR组（接受PUVCR,23例）和后路椎体切除术（PVCR）组（接受PVCR,26例）.两组患者术前一般资料比较差异均无统计学意义（P＞0.05）,具有可比性.记录并比较两组患者手术时间、术中出血量、术后引流量、后凸cobb角矫正情况、神经功能改善情况及疼痛评分的缓解程度. 结果 与PVCR组比较,PUVCR组的手术时间更短、术中出血量更少、术后引流量更少,差异均有统计学意义（P＜0.05）.术后2周后凸cobb角的矫正度和术后1年后凸cobb角矫正丢失度两组间比较,差异均无统计学意义（P＞0.05）.术后1年神经功能改善情况和疼痛评分缓解程度两组间比较,差异均无统计学意义（P＞0.05）. 结论 对于陈旧性胸腰段椎体压缩骨折伴后凸畸形,PUVCR可取得与传统截骨方式相同程度的后凸畸形矫正、神经功能恢复及疼痛改善,但手术时间更短、出血更少、神经损伤发生率更低.

Objective To describe a successful method by which vertebral column resection is performed through a unilateral posterior approach for old thoracolumbar compressive fracture accompanied with kyphotic deformity.Methods From February 2009 to January 2013,49 patients with old thoracolumbar compressive fracture accompanied with kyphotic deformity were treated at our department.Twenty-three of them were treated by posterior unilateral vertebral column resection （PUVCR）,and 26 by posterior vertebral column resection （PVCR）.The 2 groups were compatible in general clinical data （P 〉 0.05）.Their clinical records were reviewed and compared in terms of operation time,intraoperative blood loss,postoperative drainage,correction of kyphotic deformity,neural functional improvement by Oswestry disability index （ODI）,and pain by visual analogue scale （VAS）.Results The operation time,intraoperative blood loss and postoperative drainage in the PUVCR group were significantly less than in the PVCR group （P 〈 0.05）.There were no significant differences between the 2 groups in terms of correction of kyphotic angle （P =0.523） postoperatively or loss of correction （P =0.146） at one-year follow-up （P 〉 0.05）.No significant differences were observed between the 2 groups either in terms of improved ODI or decreased VAS at one-year follow-up （P 〉 0.05）.Conclusions In treatment of old thoracolumbar compressive fracture accompanied with kyphotic deformity,PUVCR can achieve satisfactory correction of sagittal deformity,neural functional improvement and pain relief as well as conventional osteotomy,but it has advantages of shorter operation time,reduced blood loss and decreased incidence of nerve root impingement.