经椎间隙有限脊柱中后柱截骨治疗陈旧性胸腰椎压缩骨折

Effectiveness of limited middle and posterior column osteotomy via transvertebral space approach for old thoracolumbar compression fracture

目的探讨经椎间隙有限脊柱中后柱截骨治疗陈旧性胸腰椎压缩骨折的疗效。方法回顾分析2010年1月—2018年3月符合选择标准的47例陈旧性胸腰椎压缩骨折患者临床资料。其中25例(A组)接受经椎间隙有限脊柱中后柱截骨,22例(B组)接受经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO)。两组患者性别、年龄、致伤原因、受伤至手术时间、骨折节段以及术前后凸Cobb角、脊柱矢状面轴向距离(sagittal vertical axis,SVA)、疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、术中出血量、术后并发症发生情况,术后后凸Cobb角、SVA、VAS评分、JOA评分、ODI以及各指标手术前后差值,采用Frankel分级评价神经功能。结果两组手术均顺利完成,A组手术时间及术中出血量均低于B组(P<0.05)。术后切口均Ⅰ期愈合。两组患者均获随访,A组随访时间23~27个月,平均24.2个月;B组24~28个月,平均24.8个月。末次随访时,两组VAS评分、JOA评分、ODI以及后凸Cobb角、SVA与术前比较,差异均有统计学意义(P<0.05);两组间末次随访时上述指标及其手术前后差值比较,差异均无统计学意义(P>0.05)。A组术前3例存在下肢神经症状患者(Frankel D级),末次随访时提高至E级;其余患者均为E级。末次随访时,CT复查示植骨区域可见骨性融合,无内固定失败及假关节形成等并发症发生。结论对于陈旧性胸腰椎压缩骨折患者,经椎间隙有限脊柱中后柱截骨矫形效果满意,与PSO相比其在达到相同畸形矫形程度基础上还能减少手术创伤。

Objective To investigate the effectiveness of limited middle and posterior column osteotomy via transvertebral space approach in treatment of old thoracolumbar compression fracture.Methods A clinical data of 47 patients with old thoracolumbar compression fractures,who met the selection criteria between January 2010 and March2018,was retrospectively analyzed.Twenty-five patients(group A)underwent the limited middle and posterior column osteotomy via transvertebral space approach,and 22 patients(group B)underwent the pedicle subtraction osteotomy(PSO).There was no significant difference in gender,age,cause of injury,time from injury to operation,fracture segment,and preoperative Cobb angle,sagittal vertical axis(SVA),visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score,and Oswestry disability index(ODI)between the two groups(P>0.05).The operation time,intraoperative blood loss,and postoperative complications,as well as postoperative Cobb angle,SVA,VAS score,JOA score,ODI and the differences of all indexes between pre-and post-operation were recorded and compared between the two groups.The neurological function was evaluated by Frankel scale.Results The operations of both groups were successfully completed.The operation time and intraoperative blood loss in group A were significant lower than those in group B(P<0.05).All incisions healed by first intetion.All patients were followed up 23-27 months(mean,24.2 months)in group A and 24-28 months(mean,24.8 months)in group B.At last follow-up,the VAS score,JOA score,ODI,Cobb angle,and SVA of the two groups were compared with those before operation,and the differences were significant(P<0.05).There was no significant difference between the two groups(P>0.05)in the indexes at last follow-up and the difference between pre-and post-operation.The lower extremity neurological symptoms(Frankel grade D)in 3 patients of group A before operation relieved(Frankel grade E)at last follow-up.The other patients were Frankel grade E.At last follow-up,CT showed bony fusion in the grafted area without any complications such as failure of internal fixation or pseudarthrosis.Conclusion For patients with old thoracolumbar compression fractures,the limited middle and posterior column osteotomy via transvertebral space approach has a satisfactory effectiveness.Compared with PSO,it can reduce surgical trauma on the basis of achieving the same degree of deformity correction.