双侧关节突切除椎间隙松解矫形术与经椎弓根椎体截骨术治疗创伤后僵硬性胸腰椎后凸畸形的疗效对比

Comparison of the efficacies of bilateral spinal joints release orthopedics and pedicle subtraction osteotomy in the treatment of rigid post-traumatic thoracolumbar kyphosis

中文关键词:  创伤后僵硬性胸腰椎后凸畸形  经椎弓根椎体截骨  椎间隙松解技术  矫形  疗效

英文关键词:Rigid post-traumatic thoracolumbar kyphosis  Pedicle subtraction osteotomy  Bilateral spinal joints release  Orthopedics  Outcomes

中文摘要:

  【摘要】 目的：探讨双侧关节突切除、椎间隙松解（spinal joints release，SJR）矫形术与经椎弓根椎体截骨（pedicle subtraction osteotomy，PSO）矫形术治疗创伤后僵硬性胸腰椎后凸畸形（rigid post-traumatic thoracolumbar kyphosis，RPTK）的早期临床疗效。方法：回顾性分析西南医科大学附属医院自2016年1月~2022年6月应用SJR或PSO矫形术治疗的45例RPTK患者，根据矫形技术不同分为SJR组（25例）与PSO组（20例），SJR组男性13例，女性12例；顶椎分布：T11 4例，T12 10例，L1 10例，L2 1例。PSO组男性9例，女性11例；顶椎分布：T11 4例，T12 6例，L1 7例，L2 3例。两组患者性别、年龄、体质指数、病程、随访时间、顶椎分布无统计学差异（P＞0.05）。收集并比较两组患者手术相关资料，包括：内固定节段、手术时间、术中出血量、术后引流量、术中及术后并发症等临床数据。收集并分析两组患者术前和术后14d、3个月及末次随访时的腰背部疼痛视觉模拟量表（visual analogue scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）；通过术前和术后3个月、末次随访时美国脊柱损伤协会（American Spinal Injury Association，ASIA）分级、SF-36量表生理总评分（physical component score，PCS）和心理总评分（mental component score，MCS）评估神经功能及生活质量。收集并比较两组术前、术后各随访时间点整体后凸Cobb角（global kyphosis，GK）、GK矫正率、胸腰段后凸角（thoracolumbar kyphosis，TLK）等影像学参数。结果：所有患者均顺利完成手术，SJR组及PSO组均各出现1例硬脊膜破裂及1例肋间神经痛，无其他并发症发生。SJR组的手术时间、术中出血量、术后引流量分别为261.2±43.5min、446.0±144.1mL、292.3±99.0mL，PSO组分别为326.5±68.4min、1166.0±390.1mL、505.8±99.2mL，SJR组的手术时间更短、术中出血量及术后引流量更少（P＜0.001）。两组内固定节段无统计学差异（P＞0.05）。两组患者术后14d、术后3个月及末次随访时的腰背部疼痛VAS评分、ODI均较术前明显降低（P＜0.05），且术后各时间点组间比较无统计学差异（P＞0.05）。两组术后3个月、末次随访时PCS、MCS均较术前显著性升高，SJR组术后3个月的PCS较PSO组高（51.3±3.9分 vs 46.2±5.0分，P＜0.001）。两组术前GK、TLK无统计学差异（P＞0.05），术后14d、3个月及末次随访时的GK、TLK均较术前明显减小（P＜0.05），且术后各随访时间点组间比较无统计学差异；两组术后各随访时间点GK矫正率比较无统计学差异（P＞0.05）。结论：SJR与PSO矫形术治疗RPTK均能取得满意的早期临床疗效，SJR矫形术较PSO手术时间短、术中出血量和术后引流量少，早期SF-36量表评分改善更好。

英文摘要:

  【Abstract】 Objectives: This study aimed to investigate the early clinical efficacies of bilateral spinal joint release(SJR) and pedicle subtraction osteotomy(PSO) in treating rigid post-traumatic thoracolumbar kyphosis(RPTK). Methods: 45 patients with RPTK who underwent either SJR or PSO at the Affiliated Hospital of Southwest Medical University between January 2016 and June 2022 were retrospectively analyzed. The patients were divided into SJR group(n=25; 13 males, 12 females; Apical vertebrae distribution: T11 in 4 cases, T12 in 10, L1 in 10, L2 in1) and PSO group(n=20; 9 males, 11 females; Apical vertebrae distribution: T11 in 4, T12 in 6, L1 in7, L2 in 3). There wasn′t statistical difference in gender, age, body mass index, disease duration, follow-up period, or apical vertebral distribution between the two groups(P>0.05). The number of fixed segments, operative time, intraoperative blood loss, postoperative drainage volume, intra- and post-operative complications were collected and compared between the two groups. The visual analogue scale(VAS) of low back pain and Oswestry disability index(ODI) were collected and evaluated before operation, at 14d, 3 months, and final follow-up after operation. American Spinal Injury Association(ASIA) grades, SF-36 physical component score(PCS) and SF-36 mental component score(MCS) were evaluated for neurological function and living quality before operation, at 3 months and final follow-up after operation. The imaging parameters such as global kyphosis(GK) Cobb angle, GK correction rate, and thoracolumbar kyphosis(TLK) were recorded and compared before operation, at postoperative 14d, 3 months, and final follow-up between the two groups. Results: All patients successfully completed the operation, and there was 1 case of dural rupture and 1 case of intercostal neuralgia in both SJR group and PSO group, and no other complications occurred. The operative time, intraoperative blood loss and postoperative drainage volume were 261.2±43.5min, 446.0±144.1mL, 292.3±99.0mL in the SJR group, and 326.5±68.4min, 1166.0±390.1mL, 505.8±99.2mL in the PSO group, respectively. SJR group was shorter in operative time, less in intraoperative blood loss and postoperative drainage volume than PSO group(P<0.05). There was no statistical difference in the number of fixed segments between the two groups(P>0.05). The low back pain VAS score and ODI of the two groups at 14d, 3 months, and final follow-up after operation were significantly lower than those before operation(P<0.05), and there was no statistical difference between the two groups at each time point(P>0.05). The PCS and MCS were significantly increased in both groups at 3 months after operation and at final follow-up. The PCS was higher in the SJR group(51.3±3.9) than that in the PSO group(46.2±5.0) at 3 months after operation(P<0.001). There was no significant difference in GK and TLK between the two groups before operation, which decreased at 14d, 3 months and final follow-up after operation in both groups(P<0.05) and showed no statistical difference in intergroup comparisons at each time point. There was no significant difference in GK correction rate between the SJR and PSO groups at each follow-up time point(P＞0.05). Conclusions: Both SJR and PSO can achieve satisfactory early clinical outcomes in the treatment of RPTK, while SJR technique is shorter in operative time, less in intraoperative blood loss and postoperative drainage, and better in early postoperative improvement of SF-36 scale score.