前路与后路椎体次全切除重建术治疗陈旧性胸腰椎压缩骨折伴后凸畸形的疗效比较

目的 比较前路、后路椎体切除重建术治疗陈旧性胸腰段椎体压缩骨折伴后凸畸形的临床疗效。方法 回顾分析2003年1月—2012年12月于河北医科大学第三医院脊柱外科接受手术治疗的41例陈旧性胸腰段椎体压缩骨折伴后凸畸形患者的临床资料,其中20例行前方椎体次全切除固定矫形术(前路组),21例行后路单侧截骨入路椎体次全切除与重建术(后路组)。观察并比较两组手术时间,术中出血量,术前、术后1年ODI改善及疼痛缓解程度(VAS评分),后凸矫正度、术后1年矫正丢失度、钛网沉降值、钛网倾斜度,末次随访评估内固定物相关并发症、植骨融合及异位骨化的发生情况。结果 手术时间前路组为(184.3±8.1)min、后路组为(168.3±8.9)min,手术出血量前路组为(974.5±76.1)mL、后路组为(845.7±85.3)mL,差异均有统计学意义(t=6.002、5.091,P值均<0.01)。术后2周后凸Cobb角的矫正度前路组为22.3 °± 5.4°,后路组为37.1°±4.4°,差异具有统计学意义(t=9.687,P<0.01)。两组术后1年的矫正丢失度、钛网沉降值,以及冠状面、矢状面钛网倾斜度比较,差异均无统计学意义(t=0.484、0.502、1.535、0.968,P值均>0.05)。两组病例均未发生严重神经血管并发症,术后1年均获得满意植骨融合,均未发生假关节、内固定相关并发症。前路组并发术中腹膜破裂1例、术后持续性腹胀5例,后路组术后伤口延迟愈合1例。结论 对于严重陈旧性胸腰段椎体压缩骨折伴后凸畸形的手术治疗,后路手术在后凸矫正程度、缩短手术时间和减少手术出血方面优于前路,但手术方案的制定还要考虑到术者的习惯与经验。

Comparison of the clinical effect between anterior and posterior vertebral resection/reconstruction for treatment of old thoracolumbar compression fracture complicated with kyphosis

Objective To compare the clinical effect between anterior and posterior vertebral resection/ reconstruction for treatment of old thoracolumbar compression fracture combined with kyphosis.Methods From January 2003 to December 2012, 41 patients of old thoracolumbar vertebral compression fracture with kyphosis were retrospectively reviewed. Twenty patients underwent anterior corpectomy and fixation (ACF) and 21 patients undwent posterior unilateral vertebral column resection (PUVCR). Clinical evaluation: operative time, blood loss, Oswestry disability index (ODI), pain relief (visual analog scale, VAS). Radiographic evaluation: kyphosis correction, loss of correction, titanium subsidence, titanium tilt, fixation-related complications, fusion and incidence of heterotopic ossification.Results The surgery time was shorter in PUVCR group[(168.3±8.9)min] than that in ACF group[(184.3±8.1)min], the blood loss was less in PUVCR group[(845.7±85.3)mL] than that in ACF group[(974.5±76.1)mL], the differences were statistically significant(t=6.002, 5.091, all P values<0.01). The ODI improvement (t=0.281, P>0.05) and pain relief (t=0.311, P>0.05) did not show significant differences at one year of follow-up. The kyphosis correction was larger in PUVCR group(37.1°±4.4°) than that in ACF group(22.3°±5.4°) (t=9.687, P<0.01), and there was no significant difference in correction loss between PUVCR and ACF group on one year follow-up (t=0.484, P>0.05). There were no significant differences in titanium mesh subsidence (t=0.502, P>0.05), titanium tilt on AP-X ray (t=1.535, P>0.05), titanium tilt on Lateral-X ray (t=0.968, P>0.05) between PUVCR and ACF group on one year follow-up. No severe neurovascular complication occurred in both groups, and all the patients achieved satisfactory bone fusion on one year follow-up without pseudarthrosis and fixation complications. Complications included 1 patient of intraoperative intraperitoneal rupture and five patients of persistent bloating in ACF, 1 patient of wound delayed healing in PUVCR postoperatively.Conclusions PUVCR is superior in kyphosis correction, operation time shortening and blood loss decreasing, however, the surgical planning should consider the surgeon′s experience and preference.