两种截骨术式治疗胸腰椎骨折后凸畸形比较

Comparison of two osteotomy techniques for kyphosis secondary to thoracolumbar fractures

[目的]对比撑开型经椎弓根截骨术(oPSO)与经后路椎体次全切(PSVR)治疗胸腰椎陈旧性骨折伴后凸畸形的疗效。[方法]回顾性分析2013年4月~2018年1月本院手术治疗的陈旧性胸腰椎骨折后凸畸形患者36例。其中,20例采用oPSO治疗,16例采用PSVR治疗。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利完成手术,无严重术中并发症。oPSO组手术时间、术中出血量均小于PSVR组(P<0.05)。随访12~48个月,随时间推移,两组患者功能逐步改善,Frankel神经功能评级由术前oPSO组D级2例,PSVR组D组3例,末次随访时均进步为E级。末次随访两组患者ODI评分较术前显著降低(P<0.05),而JOA评分均显著增加(P<0.05)。相应时间点,两组间ODI和JOA评分的差异均无统计学意义(P>0.05)。影像方面,与术前相比,两组患者的术后后凸Cobb角显著减少(P<0.05),而椎间高度显著增加(P<0.05);术后即刻与末次随访时相比,两组的Cobb角和椎间高度均无显著改变(P>0.05)。相应时间点,两组间Cobb角和椎间高度的差异均无统计学意义(P>0.05)。[结论]oPSO及PSVR治疗胸腰椎陈旧性骨折伴后凸畸形均可取得满意的矫正和临床治疗效果。oPSO技术优于PSVR。

[Objective] To compare the clinical outcomes of opening pedicle subtraction osteotomy(oPSO) versus posterior subtotal vertebral resection(PSVR) for kyphosis secondary to thoracolumbar fractures.[Methods] A retrospective study was done on 36 patients who received surgical treatment for old thoracolumbar fractures with kyphosis deformity in our hospital From April 2013 to January 2018.Among them,20 patients who received oPSO,while the remaining 16 patients underwent PSVR.The two groups of patients were compared regarding to perioperative,follow-up and radiographic documents.[Results] All the patients in both groups had operation performed smoothly without serious intraoperative complications.The oPSO group spent significantly shorter operation time,associated with less intraoperative blood loss than the PSVR group(P<0.05).As time went in follow-up period lasted for 12~48 months,all patients in both groups got functional recovery gradually with improving Frankel scale from Grade D in 2 patients of the oPSO group and 3 patients of the PSVR group preoperatively to Grade E of the 5 patients at the latest follow up.The ODI score significantly decreased,while the JOA score significantly increased in both groups at the latest follow up in contrast to those before operation(P<0.05).However,there were no significant differences in ODI and JOA scores at any matching time point between the two group(P>0.05).With regard to imaging evaluation,the Gobb’s angle of kyphosis significantly declined,whereas the height between intervertebral spaces significantly rose pos tope rati vely with comparison to those before operation in both groups(P<0.05),both which remained unchanged in the two groups between the two time points immediately after operation and at latest follow-up(P>0.05).No statistically significant differences in the aforesaid radiographic parameters were found between the two groups at any corresponding time point(P>0.05).[Conclusion] Both oPSO and PSVR do achieve satisfactory correction and clinical results for kyphosis deformity secondary to thoracolumbar fractures.By comparison,the oPSO is considerably superior to the PSVR.