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

Clinical Effect of Different Osteotomy Methods in Treatment of Old Osteoporotic Spine Fracture with Kyphosis

目的探讨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。方法选取2017年8月至2018年8月大连市第二人民医院收治的40例陈旧性骨质疏松性脊柱骨折合并后凸畸形患者为研究对象,按照截骨方式不同分为多节段组和单节段组,每组20例。多节段组实施多节段Smith-Peterson截骨治疗,单节段组实施单节段经椎弓根楔形截骨治疗。比较两组患者的手术相关指标(手术时间、术中出血量、术后引流量、住院时间),手术前后后凸畸形Cobb角、矢状面平衡(SVA)、胸椎后凸角(TK)、腰椎前凸角(LL)、视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)。结果多节段组手术时间、住院时间短于单节段组[(136±22)min比(157±24)min,(8.7±1.4)d比(9.8±1.5)d],术中出血量和术后引流量少于单节段组[(866±47)mL比(1018±53)mL,(95±18)mL比(108±17)mL](P<0.05)。两组间Cobb角、SVA比较差异有统计学意义(P<0.001),术后Cobb角、SVA低于术前,TK、LL高于术前,不同时点间Cobb角、SVA、TK、LL比较差异有统计学意义(P<0.001);Cobb角、SVA组间与时点间交互作用差异有统计学意义(P<0.05)。术后VAS评分、ODI低于术前,不同时点间比较差异有统计学意义(P<0.001),组间与时点间交互作用差异无统计学意义(P>0.05)。多节段组患者围术期发生脑脊液渗漏1例(5.0%),单节段组3例(15.0%),两组间比较差异无统计学意义(P>0.05)。结论陈旧性骨质疏松性脊柱骨折合并后凸畸形患者采用多节段与单节段截骨方式治疗均有一定的疗效,在临床应用中应依据患者的实际情况选择合适的手术方式。

Objective To explore the clinical effect of different osteotomy methods in the treatment of old osteoporotic spine fracture with kyphosis.Methods From Aug.2017 to Aug.2018,40 cases of old osteoporosis spine fracture with kyphosis in Dalian Second People’s Hospital were included.According to the treatment method,they were divided into a multi-segment group and a single-segment group,20 cases each.The multi-segment group received multi level SmithPeterson osteotomy and the single-segment group received single level transpedicular wedge osteotomy.The surgical-related indicators(operation time,intraoperative blood loss,postoperative drainage volume,length of hospital stay),kyphosis Cobb angle,sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),visual analogue scale(VAS),Oswestry disability index(ODI)were compared between the two groups.Results The operation time and hospital stay in the multisegment group were shorter than those in the single-segment group[(136±22)min vs(157±24)min,(8.7±1.4)d vs(9.8±1.5)d],the intraoperative blood loss and postoperative drainage were less than those in the single segment group[(866±47)mL vs(1018±53)mL,(95±18)mL vs(108±17)mL](P<0.05).There was a statistically significant difference in Cobb angle and SVA between the two groups(P<0.001).The postoperative Cobb angle and SVA were lower,and TK and LL were higher than before operation.The Cobb angle,SVA,TK and LL were statistically different at different time points(P<0.001).There were statistically significant differences in Cobb angle and SVA between group and time point interactions(P<0.001).The postoperative VAS score and ODI were lower than before surgery,and there were statistically significant differences between different time points(P<0.05),and there was no statistically significant difference between group and time point interactions(P>0.05).Perioperative cerebrospinal fluid leakage occurred in 1 case(5.0%)in the multi-segment group and 3 cases(15.0%)in the single-segment group,there was no significant difference between the two groups(P>0.05).Conclusion Multi-segment and single-segment osteotomy are both effective in the treatment of old osteoporotic spine fracture with kyphosis.In clinical application,the appropriate operation method should be chosen according to the actual situation of the patients.