| 老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形后路截骨矫形的术式选择 |
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投稿时间：2018-11-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 陈建良 |
CHEN Jiang-liang |
绍兴市上虞中医医院骨伤科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
chji18168@163.com |
| 许勇 |
XU Yong |
绍兴市上虞中医医院骨伤科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
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| 万蕾 |
WAN Lei |
绍兴市上虞中医医院骨伤科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
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| 姚光校 |
YAO Guan-xiao |
绍兴市上虞中医医院骨伤科, 浙江 绍兴 312300 |
Department of Orthopaedics, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing 312300, Zhejiang, China |
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| 期刊信息：《中国骨伤》2020年，第33卷，第2期，第121-126页 |
| DOI：10.12200/j.issn.1003-0034.2020.02.006 |
| 基金项目: |
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中文摘要:
目的：观测Smith-Petersen截骨（SPO）、经椎弓根截骨（PSO）和全椎体切除截骨（VCR）3种术式治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形的矫形效果和临床疗效，探讨截骨矫形术式选择。
方法：自2015年6月至2017年8月对8例老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形患者后路截骨矫形术，患者均为陈旧性骨质疏松性胸腰椎骨折（>6个月），经过严格保守治疗3个月无效，包括应用非甾体类消炎镇痛药物、抗骨质疏松药物、针灸等。其中男3例，女5例；年龄66~83岁，平均73.4岁；病程8~60个月，平均34.6个月。8例患者共8个椎体骨折。骨折节段：T10 1个；T11 1个；T12 3个；L1 2个，L2 1个。8例患者均表现为单节段椎体陈旧性骨折楔形变引起的脊柱后凸畸形。患者胸腰段局部后凸和疼痛症状均呈渐进性发展，表现为中枢性矢状位失衡。术式选择上采用SPO截骨3例，PSO截骨3例，VCR截骨2例。通过影像学测量分析矫形效果，包括术前后脊柱后凸Cobb角，伤椎局部后凸角（localized kyphosis，LK），胸椎后凸角（thoracic kyphosis，TK），腰椎前凸角（1umbar lordosis，LL），骶骨水平角（sacral tilt angle，ST）及骶骨后上角至脊柱矢状轴线的距离（sagittal vertical axis，SVA）。采用疼痛视觉模拟评分（VAS）评估疼痛情况，应用Oswestry功能障碍指数（ODI）分析临床疗效。
结果：8例患者术后均获得随访，时间8~24个月，平均13.5个月。所有患者腰背疼痛症状明显减轻或消失，VAS评分由术前的5~8分（平均6.5分）降低至末次随访时的1~4分（平均1.88分），评分明显改善。ODI评分由术前的36~78分（平均60.25分）降低至末次随访时10~32分（平均20.38分），功能评分明显进步。随访期间X线检查可见部分患者术后植骨融合椎间隙高度稍微降低，植骨均骨性愈合，未见明显矫正度数丢失和内固定松动失败，胸腰段后凸畸形明显改善。T10-L2 Cobb角平均值由术前的25.3°矫正至2.8°，矫正率89.3%。LK由术前的平均43.4°改善为术后的7.1°，平均矫正率为86.2%。TK由术前的平均49.9°改善为术后的30.6°。LL由术前的平均43.6°减小为术后的30.8°。ST由术前的平均24.0°改善为术后的32.1°。SVA由术前平均6.23 cm减小为术后的2.40 cm。
结论：针对不同病理特征和畸形程度的老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形患者，选用SPO、PSO或VCR矫治均可取得良好矫形效果及临床疗效。 |
| 【关键词】Smith-Petersen截骨 经椎弓根截骨 全椎体切除截骨 骨质疏松 后凸畸形 |
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| Surgical choice of posterior osteotomy way for senile osteoporotic thoracolumbar fracture with kyphosis |
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ABSTRACT
Objectives: To investigate the surgical choice of posterior osteotomy way by the observation of clinical outcome of Smith-Petersen osteotomy (SPO),pedicle subtraction osteotomy (PSO) and vertebral column re-section (VCR)for senile osteoporotic thoracolumbar fracture with kyphosis.
Methods: From June 2015 to August 2017,an amount of 8 elderly patients with thoracolumbar kyphosis caused by osteoporotic vertebral fracture underwent osteotomy approach for posterior osteotomy. All patients were old osteoporotic vertebral fracture more than 6 months and received invalid conservative treatment for 3 months including nonsteroidal anti-inflammatory and analgesic drugs,anti-osteoporosis drugs and acupuncture,etc. There were 3 males and 5 females,with an average age of 73.4 years(66 to 83 years),with an average course of the disease of 34.6 months(8 to 60 months). Eight patients had a total of 8 vertebral fractures,and fracture segment was in T10 of 1 case,T11 of 1 case,T12 of 3 cases,L1 of 2 cases,L2 of 1 case. Eight patients showed kyphosis caused by wedge deformation of single segmental vertebral fractures. The thoracolumbar kyphosis and symptoms were progressively developing into central sagittal imbalance. SPO osteotomy was performed in 3 cases,PSO osteotomy in 3 cases,and VCR osteotomy in 2 cases. Orthopaedic effects were analyzed by imaging measurements,including pre-and post-operative kyphosis Cobb angle,localized kyphosis(LK),thoracic kyphosis (TK),lumbar lordosis (LL),sacral tilt angle (ST) and sagittal vertical axis (SVA). Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were used to evaluate the pain and lumbar function.
Results: All the eight patients were followed up from 8 to 24 months with an average of 13.5 months and all the symptoms of low back pain have significantly reduced or disappeared. The VAS score decreased from 5-8 points (mean 6.5 points) before surgery to 1-4 points (mean 1.88 points) at the final follow-up,and the score was significantly improved. The ODI score decreased from 36-78 points (mean 60.25 points) before surgery to 10-32 points (mean 20.38 points) at the final follow-up,and the functional score improved significantly. During the follow-up period,X-ray examination showed that some patients had a slight decrease in the height of the intervertebral fusion,and the bone graft was healed. There was no obvious corrected degree loss and internal fixation loosening,and the thoracolumbar kyphosis was significantly improved. The mean Cobb angle of T10-L2 was reduced from 25.3° to 2.8° with corrected rate of 89.3%; LK was reduced from 43.4° to 7.1° with corrected rate of 86.2%;TK was reduced from 49.9° to 30.6°,LL was reduced from 43.6° to 30.8°,and ST was changed from 24.0° to 32.1°,SVA was changed from 6.23 cm to 2.40 cm.
Conclusion: For the different pathological features and deformities of senile osteoporotic thoracolumbar fracture combined with kyphosis,SPO,PSO or VCR can achieve good orthopedic effect and clinical efficacy. |
| KEY WORDS Smith-Petersen osteotomy(SPO) Pedicle subtraction osteotomy(PSO) Vertebral column resection (VCR) Osteoporosis Kyphosis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈建良,许勇,万蕾,姚光校.老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形后路截骨矫形的术式选择[J].中国骨伤,2020,33(2):121~126 |
| 英文格式: | CHEN Jiang-liang,XU Yong,WAN Lei,YAO Guan-xiao.Surgical choice of posterior osteotomy way for senile osteoporotic thoracolumbar fracture with kyphosis[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(2):121~126 |
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