老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形后路截骨矫形的术式选择

目的:观测Smith-Petersen截骨(SPO)、经椎弓根截骨(PSO)和全椎体切除截骨(VCR)3种术式治疗老年骨质疏松性陈旧胸腰椎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:自2015年6月至2017年8月对8例老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形患者后路截骨矫形术,患者均为陈旧性骨质疏松性胸腰椎骨折(>6个月),经过严格保守治疗3个月无效,包括应用非甾体类消炎镇痛药物、抗骨质疏松药物、针灸等。其中男3例,女5例;年龄66⁸3岁,平均73.4岁;病程8⁶0个月,平均34.6个月。8例患者共8个椎体骨折。骨折节段:T₁₀1个;T₁₁1个;T₁₂3个;L₁2个,L₂1个。8例患者均表现为单节段椎体陈旧性骨折楔形变引起的脊柱后凸畸形。患者胸腰段局部后凸和疼痛症状均呈渐进性发展,表现为中枢性矢状位失衡。术式选择上采用SPO截骨3例,PSO截骨3例,VCR截骨2例。通过影像学测量分析矫形效果,包括术前后脊柱后...

Surgical choice of posterior osteotomy way for senile osteoporotic thoracolumbar fracture with kyphosis

Objectives: To investigate the surgical choice of posterior osteotomy way by the observation of clinical outcome of Smith-Petersen osteotomy (SPO),pedicle subtraction osteotomy (PSO) and vertebral column re-section (VCR)for senile osteoporotic thoracolumbar fracture with kyphosis.Methods: From June 2015 to August 2017,an amount of 8 elderly patients with thoracolumbar kyphosis caused by osteoporotic vertebral fracture underwent osteotomy approach for posterior osteotomy. All patients were old osteoporotic vertebral fracture more than 6 months and received invalid conservative treatment for 3 months including nonsteroidal anti-inflammatory and analgesic drugs,anti-osteoporosis drugs and acupuncture,etc. There were 3 males and 5 females,with an average age of 73.4 years(66 to 83 years),with an average course of the disease of 34.6 months(8 to 60 months). Eight patients had a total of 8 vertebral fractures,and fracture segment was in T₁₀ of 1 case,T₁₁ of 1 case,T₁₂ of 3 cases,L₁ of 2 cases,L₂ of 1 case. Eight patients showed kyphosis caused by wedge deformation of single segmental vertebral fractures. The thoracolumbar kyphosis and symptoms were progressively developing into central sagittal imbalance. SPO osteotomy was performed in 3 cases,PSO osteotomy in 3 cases,and VCR osteotomy in 2 cases. Orthopaedic effects were analyzed by imaging measurements,including pre-and post-operative kyphosis Cobb angle,localized kyphosis(LK),thoracic kyphosis (TK),lumbar lordosis (LL),sacral tilt angle (ST) and sagittal vertical axis (SVA). Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were used to evaluate the pain and lumbar function.Results: All the eight patients were followed up from 8 to 24 months with an average of 13.5 months and all the symptoms of low back pain have significantly reduced or disappeared. The VAS score decreased from 5-8 points (mean 6.5 points) before surgery to 1-4 points (mean 1.88 points) at the final follow-up,and the score was significantly improved. The ODI score decreased from 36-78 points (mean 60.25 points) before surgery to 10-32 points (mean 20.38 points) at the final follow-up,and the functional score improved significantly. During the follow-up period,X-ray examination showed that some patients had a slight decrease in the height of the intervertebral fusion,and the bone graft was healed. There was no obvious corrected degree loss and internal fixation loosening,and the thoracolumbar kyphosis was significantly improved. The mean Cobb angle of T₁₀-L₂ was reduced from 25.3° to 2.8° with corrected rate of 89.3%; LK was reduced from 43.4° to 7.1° with corrected rate of 86.2%;TK was reduced from 49.9° to 30.6°,LL was reduced from 43.6° to 30.8°,and ST was changed from 24.0° to 32.1°,SVA was changed from 6.23 cm to 2.40 cm.Conclusion: For the different pathological features and deformities of senile osteoporotic thoracolumbar fracture combined with kyphosis,SPO,PSO or VCR can achieve good orthopedic effect and clinical efficacy.