后路楔形截骨与椎体成形术联合长节段椎弓根螺钉内固定治疗骨质疏松性椎体骨折不愈合伴后凸畸形的疗效比较  

Comparison of pedicle subtraction osteotomy or vertebroplasty combined with long segment fixation in treating nonunion of osteoporotic vertebral fractures with kyphosis

作　　者：赵士杰[1] 李长明[1] 许建柱[1] 李强 全仁夫[1] Zhao Shijie;Li Changming;Jianzhu Xu;Li Qiang;Quan Renfu(Department of Orthopedics,Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine(Traditional Chinese Medical Hospital of Xiaoshan),Hangzhou 311201,China)

机构地区：[1]浙江中医药大学附属江南医院(杭州市萧山区中医院)脊柱外科,杭州311201

出　　处：《中华创伤杂志》2022年第9期806-813,共8页Chinese Journal of Trauma

摘　　要：目的比较后路楔形截骨(PSO)与椎体成形术(VP)联合长节段椎弓根螺钉内固定治疗骨质疏松性椎体骨折不愈合伴后凸畸形的临床疗效。方法采用回顾性队列研究分析2010年1月至2017年12月浙江中医药大学附属江南医院收治的72例骨质疏松性椎体骨折不愈合伴后凸畸形患者临床资料,其中男16例,女56例;年龄55~84岁[(68.2±5.2)岁]。骨折节段:T113例,T1219例,L131例,L219例。神经功能按美国脊髓损伤协会(ASIA)分级:D级31例,E级41例。51例采用经伤椎PSO联合长节段椎弓根螺钉内固定治疗(PSO组),21例采用VP联合长节段椎弓根螺钉内固定治疗(VP组)。比较两组手术时间、术中出血量。术前、术后2周及末次随访时测量后凸Cobb角、矢状面平衡(SVA)、胸椎后凸角(TK)及腰椎前凸角(LL),评价矫形效果;采用视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评价疼痛程度及功能改善情况。末次随访时观察ASIA分级改善情况。观察并发症情况。结果患者均获随访24~46个月[(33.2±5.9)个月]。PSO组手术时间和术中出血量长于或多于VP组(P均<0.01)。术前两组后凸Cobb角、SVA、TK、LL差异无统计学意义(P均>0.05)。术后2周两组TK差异无统计学意义(P>0.05),但PSO组后凸Cobb角、SVA明显小于VP组,LL明显大于VP组(P<0.05或0.01)。末次随访时PSO组后凸Cobb角为(8.5±1.1)°,SVA为(2.6±0.5)cm,TK为(28.8±6.2)°,VP组分别为(14.2±1.5)°、(4.4±0.9)cm、(32.6±5.9)°,PSO组明显小于VP组(P均<0.01);PSO组LL为(43.1±3.9)°,明显大于VP组的(36.9±5.3)°(P<0.01)。术前两组VAS及ODI差异无统计学意义(P均>0.05);术后2周两组间VAS及ODI差异无统计学意义(P均>0.05),但较术前均明显减少(P均<0.01);末次随访时PSO组VAS为(1.4±0.5)分,ODI为22.5±2.5,优于VP组的(1.8±0.6)分、25.5±5.1(P均<0.01)。末次随访时31例D级患者ASIA分级均恢复至E级。PSO组出现硬脊膜破裂和近端交界性后凸各1例,VP组出现骨水泥渗Objective To compare the clinical efficacy of pedicle subtraction osteotomy(PSO)versus vertebroplasty(VP)combined with long segment fixation for nonunion of osteoporotic vertebral fractures with kyphosis.Methods A retrospective cohort study was conducted to analyze the clinical data of 72 patients with nonunion of osteoporotic vertebral fractures with kyphosis admitted to Jiangnan Hospital affiliated to Zhejiang University of Traditional Chinese Medicine from January 2010 to December 2017.There were 16 males and 56 females,aged 55-84 years[(68.2±5.2)years].Level of injury was located at T11 in 3 patients,at T12 in 19,at L1 in 31,and at L2 in 19.According to the American Spinal Injury Association(ASIA)classification,31 patients were scaled as grade D and 41 grade E.Overall,51 patients were treated with PSO combined with long segment fixation(PSO group)and 21 patients treated with VP combined with long segment fixation(VP group).The operation time and bleeding volume were compared between the two groups.Before operation,at postoperative 2 weeks and at the last follow-up,the kyphotic Cobb angle,sagittal vertical axis(SVA),thoracic kyphosis(TK)and lumbar kyphosis(LL)were used to evaluate the osteotomy effect,and the visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the degree of pain and lumbar function recovery.The improvement of ASIA grade was observed at the last follow-up.The complications were observed as well.Results All patients were followed up for 24-46 months[(33.2±5.9)months].The operation time and bleeding volume were more in PSO group than in VP group(all P<0.01).Before operation,the kyphotic Cobb angle,SVA,TK and LL were not significantly different between the two groups(all P>0.05).At postoperative 2 weeks,TK was not significantly different between the two groups(P>0.05),while PSO group showed significantly decrease of kyphotic Cobb angle and SVA and increase of LL when compared with VP group(P<0.05 or 0.01).At the last follow-up,the kyphotic Cobb angle,SVA and TK in P

关 键 词：脊柱骨折 骨质疏松 截骨术 椎体成形术 

分 类 号：R687.3[医药卫生—骨科学]