陈旧性骨质疏松椎体压缩骨折继发胸腰椎后凸畸形的手术治疗

Surgical treatment of thoracolumber kyphosis secondary to old osteoporotic vertebral compression fracture

[目的]观察后路截骨矫形手术治疗陈旧性骨质疏松椎体压缩骨折（osteoporotic vertebral compression fracture,OVCF）继发胸腰椎后凸畸形的临床疗效。[方法]2004年5月-2014年7月,采用后路截骨矫形手术治疗18例陈旧性骨质疏松椎体压缩骨折继发胸腰椎后凸畸形患者。男2例、女16例,年龄54-73岁,平均65.8岁。15例采用后路经后凸顶点（椎弓根或椎间隙）截骨（PSO）闭合矫形或前方撑开后方闭合矫形术。3例采用后凸节段切除截骨（VCR）双轴旋转矫形和前柱重建术。观察手术前后的脊柱矢状位平衡（C7铅垂线与S1后上缘的水平距离,SVA）、后凸角、腰椎前凸角（LL）的变化。通过术前及末次随访JOA29评分、VAS和Oswestry功能障碍评分（ODI）的比较评估患者生活质量。应用改良Frankel分级系统评估手术前后神经功能变化。[结果]手术前后凸角度平均（45.9°±13.2°）,腰椎前凸角平均（35.9°±20.8°）,脊柱SVA平均（38.4±51.1）mm。随访时间平均51个月,末次随访后凸角度平均（10.7°±6.7°）,平均改善率76.7%,腰椎前凸角平均（27.7°±12.5°）。末次随访脊柱SVA平均（14.6±49.5）mm,平均改善率为63.2%。术前4例神经损害患者改良Frankel分级为3例D2、1例D3,术后提高至3例D3、1例E。术前腰痛VAS评分平均为6.8、JOA29评分平均为14.6、ODI评分平均为58.8%,术后腰痛VAS评分平均为2.3分、JOA29评分平均为20.2分、ODI评分平均为31.1%,相比术前明显改善,差异具有统计学意义（P〈0.05）。[结论]后路截骨矫形手术可有效治疗陈旧性OVCF继发胸腰椎后凸畸形,恢复脊柱序列,获得较好的临床效果。

[Objective] To investigate the clinical efficacy of posterior osteotomy and correction of the thoracolumber kyphosis secondary to old osteoporotic vertebral compression fractures（OVCF）.[Method]From May 2004 to July 2014,18 patients（mean age 65.8 years old） with thoracolumbar kyphosis secondary to old OVCF received surgical correction treatment.The techniques consisted of pedicle subtraction osteotomy and vertebral column resection.There were 2 cases of male and 16 cases of female.The Cobb angle of kyphosis,lumber lordosis（LL） and sagittal vertical axis（SVA） were measured before surgery,as well as the final follow-up.The modified Frankel grading system was recorded for describing the neurological function of lower extremeties.The Oswestry Disability Index（ODI） and Japanese Orthopedic Association（JOA29） for life quality,Visual Analogue Scale were evaluated preoperatively and the final follow-up.[Result]The average kyphotic angle was 45.9° ± 13.2°,the average lumbar lordosis angle was 35.9° ± 20.8°,and the average sagittal vertical axis was（38.4 ± 51.1） mm before surgery.The average follow-up duration was 51 months.At the final follow-up,the average kyphotic angle was 10.7° ± 6.7°,with an average improvement rate of 76.7%.The post-operative kyphotic angle was significantly different from that pre-operatively（P〈0.05）.The sagittal plane balance and lumber lordosis angle improved post-operatively.The modified Frankel grading were D2 in 3 cases,D3 in 1 case before surgery,and were E in 1 case,D3 in 3 cases at the final follow-up.The average ODI was 58.8% before surgery,and was 31.1% at the final follow-up.18 cases with low back pain eased in various degrees.The average post-operative VAS and JOA29 improved significantly（P〈0.05）.[Conclusion]In order to restore spinal balance and achieve good results,posterior osteotomy can be an effective treatment for the thoracolumber kyphosis secondary to the old OVCF.