经椎弓根截骨矫形术联合短节段椎弓根钉固定治疗胸腰椎陈旧性骨折后凸畸形

Pedicle Subtraction Osteotomy Associate with Short Segment Fixation for Thoracolumbar Old Fracture with Kyphosis

目的观察经椎弓根截骨矫形术(pedicle subtraction osteotomy,PSO)治疗胸腰椎陈旧性骨折后凸畸形的临床疗效并探讨短节段椎弓根钉固定的可行性及安全性。方法本研究对38例胸腰椎单节段陈旧性骨折后凸畸形手术治疗患者的临床资料进行回顾性研究分析。所纳入病例均行后路PSO截骨,其中18例行短节段(上下各1个椎体)固定,20例行长节段(上下各2个椎体)固定。通过对比分析手术前后病例两组的影像学数据及临床资料:后凸Cobb角、Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、手术时间、出血量等对治疗效果进行评估。结果38例均获随访,随访时间7~24个月。两组末次随访VAS、ODI评分均较术前明显改善(P<0.05)。短节段固定组术前Cobb角(33.0±6.0)°,术后Cobb角(6.9±3.4)℃,末次随访Cobb角(8.1±3.4)°。长节段固定组术前Cobb角(33.1±5.2)°,术后Cobb角(6.6±2.8)°,末次随访Cobb角(7.7±2.7)°。两组术后、末次随访Cobb角均较术前明显改善(P<0.05)。两组间VAS、ODI评分、Cobb角则差异无统计学意义(P>0.05)。而短节段固定组的手术时间、出血量明显低于长节段固定组(P<0.05)。两组均无内固定失败、神经脊髓血管损伤等并发症。结论PSO截骨治疗胸腰椎陈旧性骨折后凸畸形是一种有效的手术方式,短节段固定与长节段固定均可达到良好的矫正效果,矫正丢失少,且无内固定失败及严重并发症,而短节段固定创伤更小、出血量少。安全、可行。

Objective To observe the clinical efficacy of pedicle subtraction osteotomy(PSO)for thoracolumbar old fracture with kyphosis and to explore the feasibility and safety of pedicle screw fixation in short segment.Methods The study retrospectively analyzed the clinical data of 38 surgical patients with thoracolumbar single-segment kyphosis.All patients underwent posterior modified PSO,including 18 cases with short segment fixation(the upper and lower 1 vertebral body each)and 20 cases with long segment fixation(the upper and lower 2 vertebral bodies each).Analysis the preoperative and postoperative data of the two groups,such as kyphotic Cobb’s angle,visual analogue scale(VAS)score of back pain,Oswestry disability index(ODI),time of operation and bleeding volume,was done to access the effects of treatment.Results All 38 cases were followed up for 7~24 months.Both VAS and ODI improved significantly at final follow-up in the two groups(P<0.05).The Cobb’s angles in the short-segment fixed group at pre-operation,post-operation and at the last follow-up were(33.0±6.0)°,(6.9±3.4)°and(8.1±3.4)°.The Cobb’angles in the long-segment fixed group at pre-operation,post-operation and at the last follow-up were(33.1±5.2)°,(6.6±2.8)°and(7.7±2.7)°.The Cobb’angles of the two groups at postoperative and last follow-up were significantly improved compared pre-operation(P<0.05).There was no significant difference in VAS,ODI and Cobb angle between the two groups(P>0.05).The times of operation and bleeding volume of the short-segment fixed group were significantly lower than the long-segment fixed group(P<0.05).There were no complications such as internal fixation failure and neuro spinal vascular injury in both groups.Conclusion PSO osteotomy is an effective surgical method for the treatment of kyphosis deformity of old thoracolumbar fracture.Both short-segment fixation and long-segment fixation can achieve well correction results,with less correction loss,and no internal fixation failure and serious complications.Among them,the short-segment fixation is less invasive and has less bleeding volume.It is safe and feasible.