Objective: To explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis.
Methods: The clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from -3.4 to -2.1, with an average of -2.3. Lesion segments: T 11 in 2 cases, T 12 in 6 cases, L 1 in 8 cases, L 2 in 1 case, T 11, 12 in 1 case, T 12, L 1 in 2 cases, and T 12, L 2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up.
Results: No complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up ( P<0.05). There was no significant difference between at 1 week after operation and at last follow-up ( P>0.05). There was no significant difference in LL before and after operation ( F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points ( P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation.
Conclusion: Transintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients' quality of life.
目的: 探讨后路经椎间隙松解打压植骨、后柱加压闭合矫形术治疗骨质疏松性脊柱骨折伴中重度后凸畸形的安全性和初步临床效果。.
方法: 回顾性分析 2016 年 3 月－2017 年 11 月收治的 21 例老年骨质疏松性脊柱骨折伴中重度后凸畸形患者临床资料。其中男 1 例，女 20 例；年龄 55～75 岁，平均 64.8 岁。病程 8～24 个月，平均 13.1 个月。骨密度 T 值为−3.4～−2.1，平均−2.3。病变节段：T 11 2 例，T 12 6 例，L 1 8 例，L 2 1 例，T 11、12 1 例，T 12、L 1 2 例，T 12、L 2 1 例。术前神经功能根据美国脊柱损伤协会（ASIA）分级：D 级 5 例，E 级 16 例。均行经椎间隙松解撑开打压植骨、后柱加压闭合矫形椎弓根螺钉内固定术。术前、术后 3 个月及末次随访时，采用疼痛视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评价临床疗效；末次随访时采用 ASIA 分级评价神经功能。于术前、术后 1 周及末次随访时患者脊柱全长侧位 X 线片上测量局部后凸 Cobb 角（local kyphosis Cobb angle，LKCA）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）及矢状面平衡（sagittal vertebral axis，SVA）。.
结果: 患者手术时间 150～260 min，平均 193 min；术中出血量 400～1 200 mL，平均 773 mL；术中固定节段 4～9 个，平均 6.8 个。21 例患者术后均获随访，随访时间 13～22 个月，平均 17.9 个月。无内固定物断裂、神经损伤等并发症发生。术后 1 周及末次随访时的 LKCA、TK 和 SVA 均较术前显著改善（ P<0.05），术后 1 周和末次随访间差异无统计学意义（ P>0.05）；手术前后各时间点 LL 比较差异均无统计学意义（ F=3.013， P=0.057）。术后 3 个月和末次随访时 VAS 评分和 ODI 评分均较术前显著改善，末次随访时较术后 3 个月进一步改善，各时间点间差异均有统计学意义（ P<0.05）。5 例术前神经功能 ASIA 分级 D 级患者术后 6 个月随访时恢复至 E 级。.
结论: 后路经椎间隙松解打压植骨、后柱加压闭合矫形术治疗骨质疏松性脊柱骨折伴中重度后凸畸形效果确切，矫形能力强且创伤小，能有效恢复患者脊柱的矢状位平衡，缓解疼痛，改善生活质量。.
Keywords: Spine fracture; bone impaction grafting; intervertebral release; kyphosis; osteoporosis.