三种手术方式治疗陈旧性骨质疏松性脊柱骨折合并后凸畸形

Three surgical procedures for delayed osteoporotic vertebral fracture with spinal kyphosis

[目的]评价不同截骨方式治疗陈旧性骨质疏松性脊柱骨折合并后凸畸形的临床效果,并探讨其适应证。[方法]回顾性分析本院2008年12月~2014年7月采用不同截骨方式治疗的61例骨质疏松性脊柱压缩性骨折合并后凸畸形患者,其中15例采用SPO截骨（Smith-Perterson osteotomy）,32例单节段经椎弓根蛋壳截骨（pedicle subtration osteotomy,PSO）,14例采用经前柱撑开结构性植骨后柱加压闭合截骨。[结果]所有患者均获随访,时间6~65个月。截骨愈合时间3~5个月,平均3.6个月。所有患者均顺利进行手术。SPO截骨组手术时间120~190min,平均（140.5±14.5）min,术中出血量400~1 500 ml,平均（650.3±50.3）ml,术前Cobb角20°~45°,平均（26.4±9.6）°,术后恢复至6°~15°,平均（8±2.4）°,末次随访时（9±2.3）°。PSO组：手术时间163~247min,平均（206.7±19.5）min,术中出血量580~1 800 ml,平均（947.4±48.3）ml。术前Cobb角40°~50°,平均（46.2±11.2）°,术后恢复至4°~9°,平均（6.7±1.6）°,末次随访时（7±3.1）°。前柱撑开后柱加压闭合组：手术时间198~261 min,平均（236.4±20.1）min,术中出血量809~2 216 ml,平均1 350 ml,术前Cobb角52°~75°,平均（63.4±12.4）°,术后恢复至6°~16°,平均（10.0±2.1）°,末次随访时（12±3.4）°。三组患者术后及末次随访VAS评分、ODI指数较术前均有明显改善（P〈0.05）。[结论]截骨融合内固定术是治疗骨质疏松性压缩性骨折伴后凸畸形的有效方法,截骨方式的选择应根据患者病情综合考虑,制定个体化治疗方案是收到良好效果的关键。

[ Objective ] To investigate the clinical efficacy and the indications for different osteotomies for delayed osteopo- rotic vertebral fracture with spinal kyphosis. [ Method] A retrospective analysis was performed in 61 patients with delayed osteo- porotic vertebral compression fracture and spinal kyphosis who underwent osteotomy in our hospital from December 2008 to July 2014. According to different osteotomies ,they were divided into three groups：Smith -Petersen osteotomy （SPO） group （n = 15 ）, transpedicular decompression and pedicle subtraction osteotomy （PSO） （eggshell procedure） group （n = 32）, and ante- rior column open structural bone grafting and posterior column compressed -closing osteotomy （AC＆PCO） group （n = 14）. [ Result] All patients were followed up for 26.5 months （6 - 65 months）. Osseous fusion was observed at 3.6 months （ 3 - 5 months）. The operations were successfully completed in all patients. In the SPO group, the mean operation time was 140.5 ± 14. 5 min （ 120 - 190 min） ;the mean intraoperative blood loss was 650.3 ± 50.3 ml （400 - 1 500 ml） ;the Cobb angle of localized kyphosis was corrected from 26.4 ° ± 9.6 ° （20 ° - 45 ° ） preoperatively to 8 °±2.4 ° （6 ° - 15 ° ） postoperatively, and 9 °-± 2.3 ° at the last follow - up. In the PSO group, the mean operation time was 206.7 ± 19.5 min （ 163 - 247 min） ; the mean intraopera- tive blood loss was 947.4 ± 48.3 ml （580 -1800 ml） ;the Cobb angle of localized kyphosis was corrected from 46.2° ± 11.2°（40° - 50°） preoperatively to 6. 7° -± 1. 6° （4° - 9°） postoperatively, and 7° ± 3.1° at the last follow -up. In the AC＆PCO group, the mean operation time was 236.4 ± 20. 1 min （198 -261 min） ;the mean intraoperative blood loss was 1350.4 ±70.2 ml （809 -2216 ml） ;the Cobb angle of local-ized kyphosis was corrected from 63.4°± 12.4° （52° -75 °） preoperatively to 10.0° ± 2.1 ° （6° -16°） postoperatively, and 12°±3.4° at the last follow - up. After surgery, all the three groups had significant improvements in visual analogue scale score and Oswestry disability index （ P 〈 O. 05 ）. [ Conclusion ] Osteotomy combined with internal fixation is an effective treatment method for osteoporotic vertebral compression fracture with spinal kyphosis. The optimal osteotomy should be selected according to patients＇ specific conditions and the individualized therapy is essential to achieve a good treatment outcome.