后路截骨矫正陈旧性胸腰椎骨折后凸畸形

Posterior osteotomy for the correction of kyphosis secondary to old thoracolumbar fractures

摘要:

［目的］ 探讨后路截骨矫治陈旧性胸腰椎骨折后凸畸形临床疗效。［方法］ 2006 年 9 月—2019 年 6 月，分别采用 SPO、PSO、BDBO 和 PVCR 截骨矫治陈旧性胸腰椎骨折后凸畸形 41 例成人患者，男 32 例，女 9 例，平均年龄 （42.72± 12.22） 岁。评价临床与影像结果。［结果］ 所有患者均顺利完成手术，手术时间平均 （4.20±1.34） h；术中出血量平均 （1 800.25±240.50） ml。随访时间 （36.72±7.38） 个月，与术前相比，术后 12 个月和末次随访 VAS 和 0DI 评分显著减少 （P< 0.05），而身高显著增加（P<0.05），ASIA 脊髓功能分级显著改善（P<0.05）。影像方面，术后 Cobb 角、SVA 和顶椎椎管矢状径较术前显著改善 （P<0.05），后凸畸形矫正率 78.56%，所有患者均达至骨性愈合。［结论］ 后路截骨矫治胸腰椎陈旧性骨折后凸畸形可获良好疗效。

Abstract:

[Objective] To investigate the clinical outcomes of posterior osteotomy for old thoracolumbar fracture kyphosis. [Methods] From September 2006 to June 2019, 41 adult patients, including 32 males and 9 female aged (42.72±12.22) years, underwent posterior oste- otomy, involving SPO, PSO, BDBO and PVCR for kyphotic deformity secondary to old thoracolumbar fractures in our hospitals. The clinical and imaging consequences were evaluated. [Results] All patients had surgical procedures completed successfully, with operation time of (4.20±1.34) hours and intraoperative blood loss of (1 800.25±240.50) ml. At 12 months postoperatively and the latest follow-up lasted for (36.72±7.38) months on average, the VAS and ODI scores significantly decreased (P＜0.05) , while body heights significantly increased (P＜ 0.05) , and ASIA grade for neurological function grade significantly improved compared with those preoperatively (P＜0.05) . In terms of im- aging, the postoperative local kyphotic Cobb angle, SVA and sagittal diameter of the parietal vertebral canal significantly improved com- pared with those before surgery (P＜0.05) , with the kyphotic correction rate of 78.56%, and bone healing in all patients. [Conclusion] Poste- rior osteotomy does effectively correct the kyphotic deformity due to old thoracolumbar fracture in this study