经椎弓根截骨联合头尾骨水泥强化椎弓根螺钉固定治疗陈旧性骨质疏松椎体压缩骨折伴后凸畸形

目的观察后路短缩截骨联合椎弓根螺钉头尾侧骨水泥强化固定治疗骨质疏松椎体压缩骨折继发的陈旧性胸腰椎后凸畸形的临床疗效。方法选择2010年1月～2016年6月以来本院采用后路截骨矫形手术治疗骨质疏松椎体压缩骨折继发陈旧性胸腰椎后凸畸形患者12例。其中,男2例,女10例;年龄59～72岁,平均66.3岁。采用后路经后凸顶点短缩截骨闭合矫形术。观察手术前后的后凸Cobb角、腰椎前凸角(lumbar lordosis,LL)、脊柱矢状位平衡(sagittal vertical axis,SVA)改善距离的变化。通过独立人员严格随访,记录术前及末次随访JOA评分、VAS评分和Oswestry功能障碍评分(ODI),记录手术前后的Frankel分级系统分级情况。结果手术前后凸角度平均38.9°±6.2°,腰椎前凸角平均35.9°±5.8°,脊柱SVA平均(62.4±11.1)mm。随访时间平均29个月,末次随访后凸角度平均11.7°±5.7°,平均改善率69.92%;腰椎前凸角平均25.7°±10.5°,平均改善率28.41%;脊柱SVA平均(14.6±10.5)mm,平均改善率81.25%。术前12例神经损害患者Frankel分级为10例D级、2例C级,术后提高至10例E级、2例D级。腰痛VAS评分由术前平均7.8分降至术后平均2.1分、JOA评分由术前平均为13.6分增加到术后21.2分、ODI评分由术前平均为54.8%降至术后的30.1%,相比术前差异具有统计学意义(P0.05)。结论后路截骨联合椎弓根螺钉头尾侧骨水泥强化固定治疗陈旧性骨质疏松椎体压缩骨折继发胸腰椎后凸畸形,明显改善后凸畸形,能有效恢复脊柱矢状位平衡,神经功能明显改善。

Posterior spinal shortening combined with head and tail polymethylmethacrylate augmentation-screws fixation for thoracolumber kyphosis secondary to old osteoporotic vertebral compression fracture

]Objective To investigate the clinical efficacy of posterior spinal shortening combined with head and tail polymethylmethacrylate augmentation-screws for thoracolumber kyphosis secondary to old osteoporotic vertebral compression fracture. Methods From January 2010 to June 2016, 12 patients (2 males and 10 females, aged from 59 to 72 years mean age 66.3 years old) with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture received surgical correction treatment. The techniques consisted of posterior spinal shortening combined with polymethylmethacrylate augmentation-screws fixation. The Cobb angle of kyphosis, lumber lordosis(LL) and sagittal vertical axis(SVA) were measured before surgery, as well as the final follow-up. The Frankel grading system, the Oswestry disability index(ODI), Japanese orthopedic association(JOA) and visual analogue scale(VAS) were evaluated preoperatively and the final follow-up. Results The average kyphotic angle was 38.9°±6.2°, the average lumbar lordosis angle was 35.9°±5.8°, and the average sagittal vertical axis was (62.4±11.1) mm before surgery. The average follow-up duration was 29 months. At the final follow-up, the average kyphotic angle was 11.7°±5.7°, with an average improvement rate of 69.92%. The post-operative kyphotic angle was significantly different from that pre-operatively(P<0.05). The average lumber lordosis angle was 25.7°±10.5°. The average sagittal vertical axis was (14.6±10.5) mm. The lumber lordosis angle and sagittal vertical axis improved post-operatively significantly. The modified Frankel grading, VAS, ODI and JOA improved significantly (P<0.05). Conclusion Posterior spinal shortening combined with head and tail polymethylmethacrylate augmentation-screws can be an effective treatment for thoracolumber kyphosis secondary to old osteoporotic vertebral compression fracture, can improve kyphosis significantly, restore spinal balance and improve nerve function.