后路两种截骨方式治疗陈旧性胸腰段骨折合并后凸畸形的疗效比较

Efficacy comparison of two posterior osteotomy methods for old thoracolumbar compressive fracture accompanied with kyphotic deformity

目的对比后路经椎弓根椎体截骨术(PSO)与后路单侧截骨部分椎体切除固定矫形术(PUVCR)治疗陈旧性胸腰段骨折合并后凸畸形的临床疗效。方法采用回顾性病例对照研究分析2010年1月—2016年1月河北医科大学第三医院收治的51例陈旧性胸腰段骨折合并后凸畸形患者临床资料,其中男29例,女22例;年龄46~69岁,平均54.9岁。损伤节段:T1111例,T1210例,L117例,L213例。22例采用传统PSO治疗(PSO组),29例采用PUVCR治疗(PUVCR组)。比较两组患者手术时间、术中出血量、住院时间、术后2周及1年Cobb角改善程度、术后1年视觉模拟评分(VAS)及日本骨科学会(JOA)评分。观察术中及术后并发症发生情况。结果患者均获随访3~18个月,平均13.5个月。与PSO组比较,PUVCR组住院时间、术后2周Cobb角及术后1年JOA评分差异均无统计学意义[(13.8±1.1)d∶(14.1±1.2)d、(8.3±1.5)°∶(9.1±2.0)°、(26.2±1.2)分∶(25.5±1.5)分](P>0.05)。PUVCR组手术时间、术中出血量、术后1年Cobb角、术后1年VAS与PSO组比较,差异均有统计学意义[(184.9±22.9)min∶(219.9±17.1)min、(911.5±70.2)ml∶(1136.1±92.0)ml、(10.0±1.6)°∶(12.7±1.9)°、(2.3±0.5)分∶(2.9±0.7)分](P<0.01)。两组术中及术后均未发生严重并发症。结论对于陈旧性胸腰段骨折合并后凸畸形,PSO与PUVCR均能有效改善患者后凸畸形及减轻患者功能障碍,但PUVCR在缩短手术时间、减少术中出血量、改善后凸畸形及降低脊髓神经损伤发生率方面更有优势。

Objective To compare the clinical efficacy of pedicle subtraction osteotomy(PSO) and posterior unilateral vertebral column resection (PUVCR) for old thoracolumbar compressive fracture accompanied with kyphotic deformity. Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with old thoracolumbar fracture accompanied with kyphotic deformity admitted to the Third Hospital of Hebei Medical University from January 2010 to January 2016. There were 29 males and 22 females, aged 46-69 years, with an average age of 54.9 years. In terms of the injured segments, there were 11 patients with T11, 10 with T12, 17 with L1, and 13 with L2. A total of 22 patients were treated with traditional PSO (PSO group), and 29 patients PUVCR (PUVCR group). The operation time, intraoperative blood loss, hospital stay, Cobb angle improvement 2 weeks after operation and postoperative 1 year, visual analogue scale (VAS) 1 year after operation and Japanese Orthopedic Association (JOA) scores were compared between the two groups. Intraoperative and postoperative complications were recorded. Results All patients were followed up for 3-18 months, with an average of 13.5 months. There were no significant differences between PSO group and PUVCR group in hospital stay [(13.8±1.1)days vs.(14.1±1.2)days], thoracolumbar Cobb angle 2 weeks after operation [(8.3±1.5)° vs.(9.1±2.0)°] and JOA scores [(26.2±1.2)points vs.(25.5±1.5)points](P>0.05). Significant differences were found between PUVCR group and PSO group in operation time [(184.9±22.9)minutes vs.(219.9±17.1)minutes], intraoperative blood loss [(911.5±70.2)ml vs.(1136.1±92.0)ml], Cobb angle 1 year after operation [(10.0±1.6)° vs.(12.7±1.9)°], and VAS 1 year after operation [(2.3±0.5)points vs.(2.9±0.7)points](P<0.05). No serious complications occurred during operation and follow-up. Conclusions For old thoracolumbar compressive fracture accompanied with kyphotic deformity, PSO and PUVCR can both effectively improve kyphosis and relieve dysfunction. But PUVCR has the advantages of shorter operation time, less intraoperative blood loss, better-improved kyphosis, and lower incidence of spinal nerve injury.