改良SRS-Schwab Ⅳ级截骨治疗陈旧性胸腰椎骨折后凸畸形对消化功能的影响

Effects of modified SRS-Schwab grade Ⅳ osteotomy on digestive function in the treatment of kyphosis after old thoracolumbar fractures

中文关键词:  陈旧性胸腰椎骨折  后凸畸形  截骨术  消化功能

英文关键词:Old thoracolumbar fractures  Kyphosis  Osteotomy  Digestive function

中文摘要:

  【摘要】 目的：探讨改良SRS-Schwab Ⅳ级截骨术治疗陈旧性胸腰椎骨折继发脊柱后凸畸形术后患者消化功能的变化并分析相关影响因素。方法：回顾分析我院2018年1月~2020年12月行后路改良SRS-Schwab Ⅳ级截骨术治疗的36例陈旧性胸腰椎骨折继发后凸畸形患者的临床资料，其中男16例，女20例；年龄50~75岁（62.19±6.79岁），随访12~18个月（13.6±2.1个月）。在术前及末次随访时用功能性消化不良生存质量量表（functional digestive disorders quality of life questionnaire，FDDQL）和胃肠道症状评定量表（gastrointestinal symptom rating scale，GSRS）评估患者消化功能，并分别计算术前与末次随访时的差值（dFDDQL、dGSRS）；用疼痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评估疼痛和功能障碍情况，计算术前与末次随访时的差值（dVAS、dODI）；在术前及末次随访站立脊柱全长侧位X线片上测量局部后凸畸形角（focal kyphosis，FK），并计算其矫正率；用腹部矢状面在站立脊柱全长侧位X线片上的投影面积间接反应腹腔容积，在术前、末次随访站立脊柱全长侧位X线片上测量腹部矢状面的投影面积，并计算手术前后的差值。用配对样本t检验分析术前、末次随访上述各项结果的差异。采用Pearson相关性分析法分析后凸矫正率、站立脊柱全长侧位X线片上腹部矢状面面积差值与dFDDQL、dGSRS的相关性。结果：所有患者手术均顺利完成，无严重手术并发症，末次随访时消化功能FDDQL评分由术前的（73.72±5.24）%提高至（86.02±5.49）%（P＜0.001），GSRS评分由术前的33.94±2.81分降至21.44±3.19分（P＜0.001）；末次随访时腰痛VAS评分由术前的7.47±1.02分降至1.22±0.54分（P＜0.001），ODI由术前（79.74±4.89）%下降至（20.09±5.61）%（P＜0.001）；末次随访时FK由术前的44.01°±7.59°减小至7.98°±1.68°（P＜0.001），站立脊柱全长侧位X线片上腹部矢状面面积由术前的152.56±24.87cm2增加至217.24±26.08cm2（P＜0.001）。Pearson相关性分析显示，dFDDQL评分与后凸畸形矫正率、手术前后站立脊柱全长侧位X线片上腹部矢状面面积差值成正相关（r=0.542，P=0.001；r=0.738，P=0.001）；dGSRS评分与后凸畸形矫正率、手术前后站立脊柱全长侧位X线片上腹部矢状面面积差值成正相关（r=0.623，P＜0.001；r=0.772，P＜0.001）。结论：改良SRS-Schwab Ⅳ级截骨术能安全、有效地纠正陈旧性胸腰椎骨折继发后凸畸形患者后凸畸形，并能增加腹腔容积，减轻胃肠卡压，使紊乱的消化功能得以改善。

英文摘要:

  【Abstract】 Objectives: To investigate the changes of digestive function after the treatment of kyphosis secondary to old thoracolumbar fractures with modified SRS-Schwab grade Ⅳ osteotomy and analyze the related influencing factors. Methods: The clinical data of 36 patients with kyphosis after old thoracolumbar fractures who underwent posterior modified SRS-Schwab grade Ⅳ osteotomy in our hospital from January 2018 to December 2020 were retrospectively analyzed, including 16 males and 20 females, aged 50-75 years old(62.19±6.79 years old）. The patients were followed up for 12-18 months, with an average of 13.6±2.1 months. The functional digestive disorders quality of life(FDDQL) questionnaire and gastrointestinal symptom rating scale(GSRS) were used to evaluate the digestive function of patients, and the differences between before operation and at the final follow-up(dFDDQL, dGSRS) were calculated respectively; The visual analogue scale(VAS) and Oswestry disability index(ODI) were adopted to assess the pain and disability, and difference between before operation and at the final follow-up(dVAS, dODI) were calculated respectively; The focal kyphosis angle(FK) was measured on standing full-length lateral radiograph of the spine before surgery and at final follow-up, and its correction rate was figured. And the projected acreage of the sagittal plane of the abdomen on the full-length lateral radiograph of spine was employed to reflect the abdominal volume, which was measured before operation and at final follow-up, and the difference between was counted. Paired t test was adopted to analyze the respective differences of the above indicators between preoperation and final follow-up. Pearson correlation was used to analyze the correlations between kyphosis correction rate and difference of abdominal sagittal plane area on standing full-length lateral X-ray films and dFDDQL and dGSRS. Results: All patients completed the operation successfully without serious surgical complications. The final follow-up FDDQL score of digestive function increased from(73.72±5.24)% before operation to (86.02±5.49)%(P＜0.001), and the GSRS score decreased from the preoperative 33.94±2.81 to 21.44±3.19(P<0.001); the final follow-up VAS score of low back pain decreased from 7.47±1.02 before operation to 1.22±0.54(P<0.001), and the ODI decreased from (79.74±4.89)% before operation to (20.09±5.61)%(P<0.001); the final follow-up FK decreased from the preoperative 44.01°±7.59° to 7.98°±1.68°(P<0.001), and the projected acreage of the sagittal plane of abdomen on the standing full-length lateral X-ray increased from 152.56±24.87cm2 before operation to 217.24±26.08cm2(P＜0.001). Pearson correlation analysis showed that the dFDDQL score was positively correlated with the correction rate of kyphosis and the difference in the projected acreage of the abdomen on X-ray films before and after surgery(r=0.542, P=0.001; r=0.738, P=0.001); the dGSRS score was positively correlated with the correction rate of kyphosis and the difference in the projected acreage of the abdomen on X-ray films before and after surgery(r=0.623, P<0.001; r=0.772, P<0.001). Conclusions: The modified SRS-Schwab grade Ⅳ osteotomy can safely and effectively correct kyphosis secondary to old thoracolumbar fractures, improve the disordered digestive function by increasing the volume of the abdominal cavity and reducing gastrointestinal entrapment.