后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形

Posterior osteotomy way for thoracolumbar kyphosis due to delayed osteoporotic vertebral fracture in elderly

中文关键词:  骨质疏松  脊柱后凸  截骨  后凸矫形

英文关键词:Osteoporosis  Kyphosis  Ostectomy  Kyphosis correction

中文摘要:

  【摘要】 目的：评价采用后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形患者的临床效果。方法：2005年6月～2011年2月采用后路经椎弓根椎体截骨矫形术或经关节突“V”型截骨矫形术的方法治疗22例老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形的患者，男7例，女15例，平均年龄66.5岁。共30个椎体骨折，两个椎体骨折8例，单个椎体骨折14例。患者均有不同程度的腰痛，VAS评分6～9分，平均8.3分，脊髓功能Frankel分级C级1例，D级6例，E级15例。胸腰椎后凸Cobb角为38°～54°，平均47.4°。采用X线片观察Cobb角改善情况，应用VAS评分评价患者疼痛情况，应用Frankel分级评价患者脊髓功能情况。结果：9例患者接受经椎弓根椎体截骨矫形术治疗，13例患者接受经关节突“V”型截骨矫形术治疗。手术时间190～260min，平均221min；术中出血量650～1400ml，平均876ml。术后5d时Cobb角3°～14°，平均9.1°，较术前明显改善（P<0.05），改善率79.5%，术后VAS评分1～5分，平均4.2分，较术前明显改善（P<0.05），脊髓功能Frankel分级2例由E级变为D级，经营养神经治疗后恢复为E级，其余未有加重情况。术后随访3～62个月，平均20.2个月。末次随访时Cobb角5°～22°，平均12.5°，VAS评分0～6分，平均4.1分，脊髓功能Frankel分级1例C级患者改善为D级，2例D级患者改善为E级，无加重病例。影像学显示植骨融合，未见内固定断裂、松动现象。1例患者术后8个月出现固定节段上位椎体骨折，1例患者术后5个月出现固定节段上位第二个椎体骨折，均予对症、抗骨质疏松治疗后胸背痛症状缓解。结论：采用后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形可以取得良好的临床效果。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcome of posterior osteotomy for thoracolumbar kyphosis due to delayed osteoporotic vertebral fracture in elderly. Methods: From June 2005 to February 2011, a total of 22 elderly patients with thoracolumbar kyphosis caused by delayed osteoporotic vertebral fracture received transpedicular wedge osteotomy or trans-articular V shape osteotomy. There were 7 males and 15 fmales, with an average age of 66.5 years. A total of 30 vertebrae was involved, with 8 doubles and 14 singles. All patients presented with some extent of back pain, and the VAS score averaged 8.3(range, 6-9). Based on Frankle scale, there were 1 grade C, 6 grade D and 15 grade E. The kyphosis angle averaged 47.4°(range, 38°-54°). X-ray was taken before and after operation to observe Cobb angle. The soreness of patients was evaluated by VAS score and function of spinal cord was evaluated by Frankel grade. Results: 9 cases received operation of transpedicular wedge osteotomy while the other 13 cases received operation of trans-articular V shape osteotomy. The operation time was 190-260 minutes, 221 minutes in average, and the blood loss was 650-1400ml, 876ml in average. X-ray was taken 5 days after operation and Cobb angle was 3°-14°, 9.1° in average, which improved markedly than that before operation and the improvement rate was 79.5%. VAS score was 1-5, 4.2 in average, which markedly improved than that before operation. 2 cases changed from grade E to D after operation and recovered to grade E eventually after the treatment of nerve nutriment, while there was no deterioration in the other patients. All cases were followed up for 3 months to 62 months(average, 20.6 months). Cobb angle was 5°-22°, 12.5° in average. VAS score was 0-6, 4.2 in average. One case improved from grade C to D and 2 cases improved from grade D to E in Frankel degree, while there was no deterioration in the other patients. There was no instrument related complication related. There was an adjacent vertebral fracture upper the fixed segment 8 months after the operation in one case, and a second vertebral fracture upper the fixed segment 5 months after the operation in another case. The back pain were released in both cases after receiving symptomatic and anti osteoporosis treatment. Conclusions: Posterior approach for elderly patients with thoracolumbar kyphosis due to delayed osteoporotic vertebral fracture is effective and reliable.