后路经椎弓根截骨前柱重建治疗陈旧性骨质疏松性椎体压缩骨折的临床研究

PEDICLE SUBTRACTION OSTEOTOMY ASSISTED WITH ANTERIOR COLUMN RECONSTRUCTION FOR TREATMENT OF CHRONIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE

目的 评估后路经椎弓根截骨前柱重建治疗陈旧性骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture,OVCF）的临床效果。方法 2008年1月-2014年10月采用后路经椎弓根截骨前柱重建治疗陈旧性OVCF患者11例。其中男2例,女9例;年龄65~76岁,平均72.3岁。椎体压缩骨折节段：T112例,T12 2例,L1 4例,L2 2例,L3 1例。术前Oswestry功能障碍指数（ODI）为（31.1±10.2）分,伤椎后凸Cobb角为（36.5±10.2）°,于站立位全脊柱侧位X线片上测量经C7椎体中心垂线与S1椎体后上缘垂线距离为（5.2±2.5）cm。术前6例合并神经损伤,Frankel分级分别为C级4例、D级2例。记录末次随访时患者ODI评分、伤椎后凸Cobb角及C7椎体中心垂线与S1椎体后上缘垂线距离,并与术前比较;术后12个月通过过屈过伸位X线片和CT扫描观察植骨融合情况。结果 患者均顺利完成手术,无死亡、大血管损伤和截瘫等严重并发症发生。术后2例腰椎截骨患者出现下肢根性症状,1例术后出现脑脊液漏,经相应治疗后均治愈。11例均获随访,随访时间12~24个月,平均15.6个月。术后12个月观察均达骨性融合,未出现假关节形成。1例术后4个月出现钛网切割部分椎体,1例伤椎近段节段2枚椎弓根钉部分松动拔出;其余患者未出现内固定物移位和失效等并发症。末次随访时ODI评分为（13.7±5.7）分,伤椎后凸Cobb角为（7.0±15.2）°,C7椎体中心垂线与S1椎体后上缘垂线距离为（2.8±2.2）cm,均较术前显著改善（t=4.417,P=0.018;t=5.113,P=0.009;t=3.285,P=0.032）。术前合并神经损伤者中,4例Frankel C级恢复至E级1例、D级1例、无变化2例;2例D级均恢复至E级。结论 后路经椎弓根截骨前柱重建是治疗陈旧性OVCF的有效方法。

Objective To evaluate the effectiveness of pedicle subtraction osteotomy （PSO） assisted with anterior column reconstruction in the treatment of chronic osteoporotic vertebral compression fracture （OVCF）. Methods Between January 2008 and October 2014, 11 cases of chronic OVCF were treated. There were 2 males and 9 females, aged 65-76 years （mean, 72.3 years）. The vertebral compression fracture segment involved T11 in 2 cases, T12 in 2 cases, L1 in 4 cases, L2 in 2 cases, and L3 in 1 case. At preoperation, the Oswestry disability index （ODD score was 31.1±10.2; kyphosis Cobb angle of fractured vertebrae was （36.5±10.2）° on the lateral X-ray films of the spine; and distance between Cg plumb vertical line （CTPL） and sagittal vertical axis （SVA） of the S1 superior border was （5.2±2.5） cm. Six cases had spinal cord injury （SCI）, including 4 cases of Frankel grade C and 2 cases of grade D. At last foUow-up, ODI score, kyphosis Cobb angle of fractured vertebrae, and distance between C7 PL and SVA were recorded and compared with preoperative values. Postoperative Frankle scores were recorded in SCI cases. X-ray film and CT scan were taken to evaluate bone fusion at 12 months after operation. Results The operation was completed successfully without serious complications. Nerve root radiation symptoms occurred in 2 cases undergoing lumbar PSO, which was relieved after conservative treatment. Cerebrospinal fluid leakage occurred in 1 case and was cured after 2 weeks. All cases were followed up 12-24 months （mean, 15.6 months）. No internal fixation failure or pseudarthrosis was found postoperatively. Screw loosening was found in 1 case （2 screws of the upper level） and titanium Cage cutting vertebral body was found in 1 case. Bone fusion was obtained in all cases at 12 months after operation. At last follow-up, ODI score was significantly improved to 13.7±5.7 （t=4.417, P=0.018）, kyphosis Cobb angle of fractured vertebrae to （7.0±15.2）° （t=5.113, P=0.009）, and the distance between C7 PL and SVA to （2.8±2.2） cm （t=3.285, P=0.032）. In 6 SCI cases, Franlde grade was recovered to E （1 case）, to D （1 case）, and no improvement （2 cases） from C, and to E from D （2 cases）. Conclusion PSO assisted anterior column reconstruction was an effective method in treatment of chronic OVCF.