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的疗效观察

The efficacy of rear unilateral osteotomy vertebral subtotal fixation orthopedic in the treatment of old thoracolumbar vertebral compression fracture with kyphosis

目的评价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的疗效,探讨其临床适用性。方法选择从2010年5月至2015年5月于我院就诊的62例陈旧性胸腰段椎体压缩骨折伴后凸畸形患者,根据住院号分为试验组31例和对照组31例,对照组患者采用常规后路椎体全切除术,试验组患者则选择后方单侧截骨入路椎体大部分切除固定矫形术治疗。观察2组患者治疗后的一般手术情况,治疗前后腰椎影像学的改善情况,治疗前及随访1年后的功能评价和疼痛评分。结果 2组患者均顺利完成手术,但试验组患者的平均手术时间显著短于对照组患者[(186±60)min与(235±60)min,P<0.05],且术中的出血量及术后的引流量也均少于对照组患者[(878±101)mL与(1147±101)mL,(200±50)mL与(252±50)mL,P<0.05],2组患者术前的椎体后凸Cobb角比较[(38.8±2.2)°与(39.0±2.0)°,P>0.05],术后2周,患者的Cobb角、矢状位指数及伤椎楔变角均显著减小,椎体前缘高度和中缘高度恢复正常(P<0.05),且试验组和对照组患者治疗后的腰椎影像学数据变化均差异无统计学意义(P>0.05),2组患者术前的疼痛视觉模拟评分(VAS)和功能障碍ODI评分比较[(7.0±1.0)与(6.9±1.1),(72±12)%与(70±12)%,P>0.05)],随访术后1年,2项指标均显著下降(P<0.05),但试验组和对照组患者治疗后的VAS评分和功能障碍ODI评分比较均差异无统计学意义[(3.0±1.0与3.5±1.5),(23±12)%与(24±12)%,P>0.05]。结论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的临床效果更显著,创伤更小,适合临床推广应用。

Objective To analyze the efficacy of rear unilateral osteotomy vertebral subtotal fixation orthopedics in the treatment of old thoracolumbar vertebral compression fracture with kyphosis. Methods Sixty-two cases of old thoracolumbar vertebral compression fracture with kyphosis patients were selected from May 2010 to May 2015 in our hospital, and depending on the admission number, they were randomly divided into the experimental group of 31 cases and the control group of 31 patients. The control group were treated with conventional posterior vertebral resection, while the test group of patients were selected rear unilateral vertebral subtotal osteotomy fixation orthopedic surgery treatment. We observed the general situation of patients in the two groups after surgery, the improvement of lumbar imaging before and after treatment. Function evaluation and pain scores were also analyzed before surgery and after ] year follow-up. Results Two groups of patients were successfully operated, but the average operative time in the test group was significantly shorter than that in the control group [（186±60）min vs （235±60）min, P 〈0.05], and intraoperative blood loss and postoperative drainage were also less than those in the control group [（878±101）mLvs （1147±101）mL, （200±50）mLvs （252±50）mL, P〈 0.05]. For preoperative Cobb angle of two groups of patients with vertebral kyphosis, the difference was not statistically significant [（38.8±2.2）° vs （39.0±2. 0）°, P 〉0.05]. Two weeks after surgery, the patient＇s Cobb angle, sagittal index and vertebral wedging angle, vertebral height and the height of the edge were significantly reduced, and the differences were statistically significant （ P 〈0.05）, and the difference of lumbar imaging data changes between the test group and control group after treatment was not statistically significant （ P 〉0.05）. The differences of VAS score and ODI score of patients in two groups preoperative were not statistically significant [（7.0± 1.0）% vs（6.9±1.1）, （72± 12）% vs （70± 12）, P 〉0.05]. After 1 year of follow-up, two indicators decreased significantly （ P 〈0.05）, but there was no significant difference for the VAS score and ODI score between the test and control group[（3.0±1. 0） vs （3.5±1.5）,（23±12）% vs （245±12）%, P 〉0. 05]. Conclusion Rear unilateral osteotomy vertebral subtotal fixation orthopedic in the treatment of old thoracolumbar vertebral compression fracture with kyphosis, the clinical effect is more pronounced, less invasive, suitable for long-term clinical application.