多节段与单节段截骨治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形的疗效比较

摘要

Objective To investigate the sagittal correction effect and clinical efficacy of multisegment Smith-Peterson osteotomy (SPO) and single-segment pedicle subtraction osteotomy (PSO) in the treatment of old osteoporotic vertebral compression fracture (OVCF)combined with kyphosis.Methods A retrospective case control study was conducted to analyze the clinical data of 24 patients with old OVCF combined with kyphosis admitted to Traditional Chinese Medical Hospital of Xiaoshan from February 2014 to July 2016.There were 10 males and 14 females,aged 58-72 years,with an average of 65.6 years.Thirteen patients were treated with multi-segment SPO (Group A),six of whom underwent two-segment SPO and seven underwent three-segment SPO.Eleven patients were treated with single-segment PSO (Group B).The operation time,intraoperative bleeding volume,the number of cases using cementreinforced nail track,postoperative drainage,hospitalization time and postoperative complications were compared between the two groups.Cobb angle,sagittal vertical axis (SVA),thoracic kyphosis angle (TK) and lumbar lordosis angle (LL) of kyphosis deformity were measured before operation,after operation and at the last follow-up.Oswestry Dysfunction Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate the clinical efficacy at the last follow-up.Results All patients were followed up for 6-24 months,with an average of 15.4 months.The operation time of Group A was (198.1 ± 27.3)minutes,while that of Group B was (237.6 ± 36.1)minutes (P ＜ 0.05).The amount of intraoperative bleeding in Group A was (1 256.2 ± 389.4) ml,while that in Group B was (1 525.6 ±457.1)ml (P ＜ 0.05).Two patients in Group A and five patients in Group B were treated with cement-reinforced nail track (P ＜ 0.05).There was no significant difference in drainage and hospitalization time between the two groups (P ＞ 0.05).Three patients in Group A and one patient in Group B had cerebrospinal fluid leakage (P ＜ 0.05).The postoperative SVA was (1.4 ± 0.7) cm in Group A and (-1.1 ± 0.6) cm in Group B (P ＜ 0.05).No significant differences were found between the two groups in Cobb angle,TK and LL of kyphosis (P ＞ 0.05).There was no significant difference in SVA,Cobb angle,TK and LL between the two groups at the last follow-up (P ＞ 0.05).There was no significant difference in ODI and VAS between the two groups after operation and at the last follow-up (P ＞ 0.05).No complications such as spinal cord injury,embolism caused by cement leakage,extraction or rupture of pedicle screw occurred in either group.Conclusion For old osteoporotic vertebrae compressed fractures combined with kyphosis,multi-segment SPO and single-segment PSO can achieve good sagittal correction and clinical efficacy.Single-segment PSO has better correction effect and lower incidence of cerebrospinal fluid leakage,yet accompanied with disadvantages of overcorrection,screw loosening,longer operation time and more blood loss.%目的 探讨多节段Smith-Peterson截骨(SPO)与单节段经椎弓根楔形截骨(PSO)治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形的矢状面矫正效果和临床疗效.方法 采用回顾性病例对照研究分析2014年2月-2016年7月杭州市萧山区中医院收治的24例陈旧性胸腰椎骨质疏松性骨折伴后凸畸形患者临床资料,其中男10例,女14例;年龄58 ～72岁,平均65.6岁.13例采用多节段SPO治疗(A组),其中6例行2个节段SPO,7例行3个节段SPO.11例采用单节段PSO治疗(B组).比较两组手术时间、术中出血量、术中使用骨水泥强化钉道例数、术后引流量、住院时间及术后并发症.测量患者术前、术后及末次随访时后凸畸形Cobb角、矢状面平衡(SVA)、胸椎后凸角(TK)、腰椎前凸角(LL)以评价矫形效果.术后及末次随访时采用Oswestry功能障碍指数(ODI)、视觉模拟评分(VAS)评价临床疗效.结果 患者均获随访6～ 24个月,平均15.4个月.A组手术时间为(198.1 ±27.3) min,B组为(237.6 ±36.1)min(P ＜0.05).A组术中出血量为(1 256.2±389.4) ml,B组为(1 525.6 ±457.1)ml(P＜0.05).A组使用骨水泥强化钉道2例,B组为5例(P＜0.05).术后引流量、住院时间比较差异均无统计学意义(P＞0.05).A组脑脊液漏3例,B组为1例(P＜0.05).A组术后SVA为(1.4 ±0.7)cm,B组为(-1.1±0.6)cm(P＜0.05).两组术后后凸畸形Cobb角、TK、LL比较差异均无统计学意义(P＞0.05).末次随访两组SVA、Cobb角、TK、LL比较差异均无统计学意义(P＞0.05).两组术后及末次随访ODI、VAS比较差异无统计学意义(P＞0.05).两组均无脊髓损伤、骨水泥渗漏致栓塞及椎弓根螺钉拔出、断裂等并发症.结论 多节段SPO与单节段PSO治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形均可取得较好的矫形效果和临床疗效.单节段PSO矢状面矫正效果更佳,脑脊液漏发生率更低,但存在过度矫正,同时手术时间更长,术中出血量更多,螺钉易松动.