陈旧性胸腰椎骨折伴后凸畸形的截骨矫形术式选择

Selection of osteotomy in patients with thoracolumbar posttraumatic kyphosis secondary to old fracture

中文关键词:  经椎弓根截骨  Smith-Petersen截骨  胸腰段脊柱  创伤性后凸畸形

英文关键词:Pedicle subtraction osteotomy  Smith-Petersen osteotomy  Thoracolumbar vertebra  Posttraumatic kyphosis

中文摘要:

  【摘要】 目的：观测经椎弓根截骨（PSO）与Smith-Petersen截骨（SPO）两种术式治疗胸腰椎陈旧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：2006年3月～2014年12月，对47例创伤性后凸畸形患者进行了截骨矫形手术。其中男30例，女17，年龄22～69岁，平均42.5±15.5岁。均为陈旧性胸腰椎骨折导致的创伤性后凸畸形。47例患者主诉均为腰背部疼痛。针对不同病理特征和畸形程度，32例行PSO矫形，15例行SPO矫形。PSO手术在病椎行经椎弓根楔形截骨矫形，SPO手术在病椎上下及相邻间隙做2～3节段SPO截骨矫形。通过术前、术后和末次随访全脊柱正侧位X线片，测量后凸畸形Cobb角及矢状面平衡（SVA），分析两种方法矫形效果，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）分析两种方法临床疗效。结果：47例中有42例获得随访，其中PSO手术29例，SPO手术13例。随访时间8～48个月，平均29.4±7.8个月。42例均获得骨性融合。后凸畸形Cobb角PSO组术前为41.8°±10.5°，术后为2.6°±1.2°，末次随访时为3.2°±1.3°，矫正率92.3%；SPO组术前为40.2°±9.6°，术后为4.9°±2.3°，末次随访时为5.3°±3.5°，矫正率86.8%。两组术后、末次随访时Cobb角与术前相比均有显著性差异（P＜0.05）。PSO组SVA术前为5.0±4.1cm，术后为-0.6±2.2cm，末次随访时为1.2±1.5cm；SPO组SVA术前为3.5±2.2cm，术后为0.8±0.6㎝，末次随访时为1.3±1.1cm。两组术后、末次随访时SVA与术前相比均有显著性差异（P＜0.05）。PSO组VAS术前为6.46±1.72，末次随访时为0.91±0.59，ODI术前为（69.4±12.1）%，末次随访时为（23.7±11.5）%；SPO组VAS术前为6.51±1.87，末次随访时为2.08±0.75，ODI术前为（68.1±16.3）%，末次随访时为（33.1±12.5）%，两组随访VAS和ODI与术前相比有显著性差异（P＜0.05）。结论：针对不同病理特征和畸形程度的胸腰椎陈旧骨折伴后凸畸形患者，选用PSO或SPO矫治均可取得良好矫形效果及临床疗效。

英文摘要:

  【Abstract】 Objectives: To investigate clinical outcome of pedicle subtraction osteotomy(PSO) and Smith-Petersen osteotomy(SPO) for thoracolumbar posttraumatic kyphosis. Methods: From March 2006 to December 2012, a total of 47 cases with posttraumatic kyphosis undergoing surgery were retrospectively analyzed, including 32 cases of PSO and 15 of SPO according to various pathological features and deformity. All patients with old kyphosis of thoracolumbar presented with back pain. PSO in one level and SPO in two or three levels were performed. Radiologic assessment included pre-, post-operative and follow-up Cobb angle and SVA in X-ray films. The visual analogue scale(VAS) and Oswestry disability index(ODI) were evaluated before surgery and at follow-up. Results: Forty two of the forty seven patients were followed up by 8 months to 48 months(average, 29.4±7.8 months), including 29 cases of PSO and 13 cases of SPO. Cobb angle in PSO group decreased from 41.8°±10.5° preoperatively to 2.6°±1.2° postoperatively and increased to 3.2°±1.3° at final follow-up. The correction rate was 92.3%. Cobb angle in PSO group decreased from 40.2°±9.6° preoperatively to 4.9°±2.3° postoperatively and increased to 5.3°±3.5° at final follow-up. The correction rate was 86.8%. Significant differences were observed(P＜0.05) in Cobb angle at postoperation and at final follow-up comparing to that of preoperation in both groups. SVA in PSO group decreased from 5.0+4.1cm preoperatively to －0.6+2.2cm postoperatively and increased to 1.2+1.5cm at final follow-up. SVA in PSO group decreased from 3.5+2.2cm preoperatively to 0.8+0.6cm postoperatively and increased to 1.3+1.1cm at final follow-up. Significant differences were observed(P＜0.05) in SVA at postoperation and at final follow-up comparing to that of preoperation in both groups. The VAS and ODI improved significantly in both groups at follow-up(P＜0.05). 42 cases got bony fusion. Conclusions: The PSO and SPO can obtain substantially correction and clinical result for thoracolumbar posttraumatic kyphosis according to various pathological features and deformity.