AOPC截骨内固定治疗陈旧性单节段胸腰段OVCF伴后凸畸形的疗效

Outcome of AOPC osteotomy and internal fixation for old single-level thoracolumbar OVCF with kyphosis

目的探讨后路前方撑开—后方闭合(AOPC)截骨矫形术治疗陈旧性单节段胸腰段骨质疏松性椎体压缩骨折(OVCF)伴后凸畸形的临床疗效。方法纳入陈旧性单节段胸腰段OVCF患者53例进行回顾性分析,均接受AOPC截骨矫形术治疗。记录患者围术期指标及并发症发生情况。术前及末次随访时行脊柱胸腰椎正侧位X射线检查测量胸椎后凸Cobb角、胸腰段后凸角和腰椎前凸角等矢状位参数。采用日本骨科学会(JOA)评分评价脊髓功能,分别采用视觉模拟量表(VAS)及Oswestry功能障碍指数(ODI)评价腰背部疼痛及腰椎功能。结果所有患者手术均顺利完成,手术时间为(287.1±19.9)min,术中出血量为(1240.9±105.1)mL,住院时间为(11.7±1.4)d;围术期未出现严重神经及血管损伤等并发症,末次随访时所有患者内固定位置良好、牢靠。术后6个月胸椎后凸Cobb角与术前比较,差异无统计学意义(P>0.05),胸腰段后凸角较术前减小(P<0.05),腰椎前凸角较术前增大(P<0.05)。术后6个月JOA评分高于术前(P<0.05),VAS评分及ODI低于术前(P<0.05)。结论AOPC截骨矫形术治疗陈旧性单节段胸腰段OVCF可充分进行环形360°脊髓减压,恢复脊髓神经功能,重建脊柱序列,疗效满意。

Objective To investigate the clinical outcome of anterior opening-posterior closing(AOPC)osteotomy in the treatment of old single-level thoracolumbar osteoporotic vertebral compression fracture(OVCF)with kyphosis.Methods A total of 53 patients with old single-level thoracolumbar OVCF who received AOPC osteotomy treatment were retrospectively enrolled.The perioperative indicators and the occurrence of complications were recorded.The sagittal parameters such as the Cobb angle of the thoracic kyphosis,thoracolumbar kyphosis angle,and the lumbar lordosis angle were measured by spine thoracolumbar positive and lateral X-rays before operation and at the last follow-up.The spinal cord function was evaluated by the Japanese Orthopaedic Association(JOA)score,and the visual analogue scale(VAS)and the Oswestry dysfunction index(ODI)were used to evaluate the back pain and lumbar function respectively.Results The operations for all patients were successfully completed,with the operation time of(287.1±19.9)minutes,the intraoperative blood loss of(1240.9±105.1)mL,and the hospital stay of(11.7±1.4)days;there were no complications related to serious nerves or blood vessels injuries during the perioperative period,and the internal fixation position of all patients was good and reliable at the last follow-up.There was no significant difference in the Cobb angle of the thoracic kyphosis 6 months after operation compared with that before operation(P>0.05),the thoracolumbar kyphosis angle was smaller than that before operation(P<0.05),and the lumbar lordosis angle was larger than that before operation(P<0.05).The JOA score 6 months after operation was higher than that before operation(P<0.05),and the VAS score and ODI 6 months after operation were lower than those before operation(P<0.05).Conclusion AOPC osteotomy in the treatment of old single-level thoracolumbar OVCF can fully perform circular 360°spinal decompression,restore spinal nerve function and reconstruct spinal alignment,with satisfactory efficacy.