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 the Treatment of old Osteoporotic Spine Fracture with Kyphosis

目的:分析临床以不同截骨方式治疗陈旧性骨质疏松性(OP)脊柱骨折(spinal fractures,SF)合并后凸畸形(以下简称:陈旧性OPSF合并后凸畸形)的效果.方法:选择自2017年6月-2019年6月间我院收治的60例陈旧性OPSF合并后凸畸形患者为本研究样本.依据截骨技术的差异性将其分成单节段组(n=30,给予PSO截骨疗法)与多节段组(n=30,给予Smith-Peterson截骨疗法).对比2组手术各项指标(手术用时、出血量、住院用时等);矫形效果[手术前与手术后后凸畸形Cobb角、胸椎后/前凸角(TK、LL)以及矢状面平衡(SVA)];不良反应发生率.结果:多节段组手术与住院用时、术中出血量以及术后引流量均较单节段组少(P<0.05).术前,2组Cobb角、SVA、TK、LL差异均不大(P>0.05);术后,多节段组Cobb角大于单节段组(P<0.05),SVA小于单节段组(P<0.05),2组TK、LL差异仍不大(P>0.05).2组均未发生断钉断棒、脊髓损伤与骨水泥渗漏不良反应.多节段组总发生3例(10.00%)不良反应,且未出现形成假关节不良反应,明显低于单节段组11例(36.67%)的发生情况(P<0.05).结论:治疗陈旧性OPSF合并后凸畸形不论采用单节段还是多节段截骨疗法均可能实现治疗目标,但多节段法并发症更少,手术各项指标更优异,临床应用更安全,且术后改善情况更好,在可选择的范围内建议优选.

Objective:To analyze the clinical effect of different osteotomy methods in the treatment of old osteoporotic(OP)spinal fractures(spinal fractures,SF)with kyphosis(hereinafter referred to as:old OPSF with kyphosis).Methods:Selected 60 patients with aged OPSF complicated with kyphosis admitted from 2017.06-2019.06 as the sample of this report.They were divided into single segment group(n=30,given PSO osteotomy therapy)and multi-segment group(n=30,given Smith-Peterson osteotomy therapy)according to the difference of osteotomy technique.Comparison of the two groups of surgical indicators(operation tim e,blood loss,hospitalization time,etc.).);orthop)edic effects pre-and post-operative kyphosis Cobb angle,posterior thoracic/predominant angle(TK,LL)and sagittal balance(SVA);Incidence of adverse reactions.Results:The operation and hospitalization time,intraoperative bleeding volume and postoperative drainage volume of multi-segmental group were less than those of single-segment group(P<0.05).There was no significant difference in Cobb angle and SVA^TK^LL between the two groups before operation(P>0.05).the SVA was smaller than that of the single segment group(P<0.05),and the TK^LL difference between the two groups was still small(P>0.05).In both groups,the adverse effects of broken nail rod,spinal cord injury and cement leakage occurred.A total of 3(10.00%)adverse reactions occurred in the multi-segmental group,and no adverse reactions were found to form false joints,which was significantly lower than that in 11 cases(36.67%)in the single-segment group(P<0.05).Conclusion:The treatment of old OPSF complicated with kyphosis may achieve the goal either by single or multi-segment osteotomy therapy,but the complications of multi-segmental method are less,the operative indexes are better,the clinical application is safer,and the postoperative improvement is better.