后路S-P截骨矫形椎弓根内固定治疗老年胸腰段重度椎体压缩骨折合并后凸畸形

Posterior Smith-Peterson osteotomy and transpedicle internal fixation for the treatment of senile thoracolumbar severe vertebral compression fracture with kyphosis

目的：探讨后路S-P截骨矫形椎弓根螺钉内固定治疗老年性胸腰段重度椎体压缩骨折合并后凸畸形的手术方法及疗效。方法对24例老年胸腰段重度椎体压缩骨折合并后凸畸形患者采取后路S-P截骨矫形椎弓根螺钉内固定手术治疗。结果手术时间1．8~2．8（2．4±0．4）h；术中出血量240~460（320±85）ml。 S-P截骨1~3（1．8±0．4）处。24例均获随访，时间18~42（26±12．4）个月。矢状面后凸Cobb角：术前22°~48°（35．6°±13．4°），末次随访时5．2°~10．4°（8．4°±2．6°），矫正率70．4%~78．6%（76．6%±2．2%）（P 〈0．01）。 JOA下腰痛评分：术前4~9（6．4±2．1）分，末次随访时20~24（21．6±2．8）分，改善率73．6%±4．2%（P〈0．01）。 ODI 评分：术前32~44（37．4±5．5）分，末次随访时8~14（11．6±2．8）分，改善率66．9%±2．4%（P〈0．01）。结论 S-P截骨矫形椎弓根螺钉内固定治疗老年胸腰段重度椎体压缩骨折合并后凸畸形手术创伤小，安全性高，对轻中度的后凸畸形具有良好的矫正效果。

Objective To evaluate operative method and effect of posterior Smith-Peterson osteotomy and transpedicle internal fixation for the treatment of elderly thoracolumbar severe vertebral compression fracture with kyphosis. Meth-ods 24 patients with elderly thoracolumbar severe vertebral compression fracture and kyphosis underwent operations by posterior Smith-Peterson osteotomy and transpedicle internal fixation. Results The duration of surgery was 1. 8~2.8（2.4±0.4）h;andtheintraoperativebloodlosswas240~460（320±85）ml.TheSmith-Petersonosteotomywere 1~3（1. 8 ± 0. 4）. All cases were followed up for 18~42（26 ± 12. 4）months. The sagittal kyphosis Cobb angle was de-creased from 22°~48° （35. 6° ± 13. 4°） preoperatively to 5. 2°~10. 4°（8. 4° ± 2. 6°）at the last follow-up and correc-tion rate was 70. 4% ~78. 6% （76. 6% ±2. 2%） （P〈0. 01）. The JOA score of low lumbar pain was increased from 4~9 （6. 4 ± 2. 1）preoperatively to 20~24 （21. 6 ± 2. 8） at the last follow-up and correction rate was 73. 6% ± 4. 2%（P〈0. 01）. The ODI score was decreased from 32~44（37. 4 ± 5. 5）preoperatively to 8~14（11. 6 ± 2. 8） at the last follow-up and correction rate was 66. 9% ± 2. 4%（P〈0. 01）. Conclusions It is small operative trauma, high safe to treat elderly thoracolumbar severe vertebral compression fracture with kyphosis by posterior Smith-Peterson osteotomy and transpedicle internal fixation. The mild to moderate kyphosis can be got good corrective effect.