中国修复重建外科杂志

中国修复重建外科杂志

SRS-Schwab 级截骨联合卫星棒技术治疗胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形

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目的探讨 SRS-Schwab Ⅳ 级截骨联合卫星棒技术治疗胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形疗效。方法2013 年 4 月—2016 年 8 月,采用 SRS-SchwabⅣ级截骨联合卫星棒技术治疗 20 例胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形女性患者。患者年龄 49~71 岁,平均 54.8 岁。病程 6~28 个月,平均 14 个月。骨密度 T 值为–4.4~–1.8,平均–2.8。术前后凸 Cobb 角为(43.0±11.3)°。椎体压缩骨折节段:T12 9 例,L1 8 例,L2 3 例。术前神经功能 Frankel 分级:D 级 5 例,E 级 15 例。记录手术时间、术中出血量及并发症发生情况;比较术前、术后 3 个月及末次随访时后凸 Cobb 角和矢状面垂直轴(sagittal vertical axis,SVA);术前及末次随访时采用 Oswestry 功能障碍指数(ODI)评价临床疗效,从疼痛程度、日常生活自理能力、提物、行走、坐、站立、睡眠、社会活动、旅行进行评价。结果手术时间 180~314 min,平均 226 min;术中出血量 390~1 800 mL,平均 750 mL。所有患者切口均Ⅰ期愈合。20 例均获随访,随访时间 24~52 个月,平均 30.9 个月。随访期间无明显矫形丢失、断钉、断棒、假关节形成、近端交界性后凸和远端交界性后凸等并发症发生,术后 12 个月时截骨均达骨性融合。术后患者均能直立行走,6 个月时疼痛程度较术前明显减轻。术前 5 例伴有神经损害患者,末次随访时神经功能均改善至 Frankel E 级。末次随访时 ODI 各项评分均较术前明显改善(P<0.05)。术后 3 个月和末次随访时后凸 Cobb 角均较术前显著改善(P<0.05);术后 3 个月和末次随访间比较差异无统计学意义(P>0.05)。手术前后各时间点 SVA 比较差异均无统计学意义(P>0.05)。结论SRS-Schwab Ⅳ 级截骨联合卫星棒技术治疗胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形,可以获得满意矫形和良好疗效。

ObjectiveTo evaluate the effectiveness of SRS-Schwab grade Ⅳ osteotomy combined with satellite rod for thoracolumbar old osteoporotic fracture with severe kyphosis.MethodsBetween April 2013 and August 2016, 20 cases of thoracolumbar old osteoporotic fracture with severe kyphosis were treated with SRS-Schwab grade Ⅳ osteotomy combined with satellite rod. All the patients were females, aged 49-71 years (mean, 54.8 years). The disease duration was 6-28 months with an average of 14 months. The T value of bone density was –4.4 to –1.8 (mean, –2.8). The preoperative Cobb angle was (43.0±11.3)°. The vertebral compression fracture segment was T12 in 9 cases, L1 in 8 cases, and L2 in 3 cases. Preoperative spinal cord function was evaluated by Frankel classification; there were 5 cases of grade D and 15 cases of grade E. The operation time, intraoperative blood loss, and perioperative complication were recorded. The Cobb angle for kyphosis and sagittal vertical axis (SVA) were recorded beforeoperation, at 3 months after operation, and at last follow-up. Oswestry disability index (ODI) was used to evaluate the effectiveness before operation and at last follow-up, and the evaluation indicators included pain degree, daily life self-care ability, extracting, walking, sitting, standing, sleeping, social activities, and traveling.ResultsThe operation time was 180-314 minutes (mean, 226 minutes). The intraoperative blood loss was 390-1 800 mL (mean, 750 mL). All the incisions healed by first intension without incision infection. Twenty patients were followed up 24-52 months, with an average of 30.9 months. During the follow-up period, no significant complication such as correction loss, nail breakage, rod breakage, pseudoarthrosis formation, or proximal and distal junctional kyphosis occurred. All patients were able to walk upright after operation, and the pain relieved significantly at 6 months after operation. Bone fusion achieved at 12 months after operation. The Frankel grade of nerve function improved from grade D to grade E at last follow-up in 5 patients with nerve damage before operation. At last follow-up, the indicator scores of ODI significantly improved when compared with preoperative values (P<0.05). Cobb angle significantly improved at 3 months after operation and at last follow-up (P<0.05) when compared with preoperative one, but there was no significant difference in the Cobb angles between 3 months after operation and last follow-up (P>0.05). There was no significant difference in SVA between pre- and post-operation (P>0.05).ConclusionSRS-Schwab grade Ⅳ osteotomy combined with satellite rod for thoracolumbar old osteoporotic fracture with severe kyphosis is effective in achieving satisfactory clinical outcomes, as well as maintaining correction of kyphosis.

关键词: SRS-Schwab Ⅳ 级截骨; 后凸畸形; 胸腰椎; 陈旧性骨折; 骨质疏松; 卫星棒

Key words: SRS-Schwab grade Ⅳ osteotomy; kyphosis; thoracolumbar spine; old fracture; osteoporosis; satellite rod

引用本文: 张银昌, 赵清华, 秦晓东, 邱勇, 朱泽章. SRS-Schwab 级截骨联合卫星棒技术治疗胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形 . 中国修复重建外科杂志, 2019, 33(3): 259-264. doi: 10.7507/1002-1892.201808022 复制

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1. Saita K, Hoshino Y, Higashi T, et al. Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis. Spinal Cord, 2008, 46(1): 16-20.
2. Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2015, 74(1): 112-120.
3. 邱勇, 朱泽章, 王斌, 等. 严重脊柱侧后凸畸形后路全脊椎截骨术后残留后凸畸形的原因及处理策略. 中华骨科杂志, 2008, 28(1): 14-19.
4. 刘臻, 邱勇, 史本龙, 等. 围截骨区卫星棒技术在严重脊柱畸形三柱截骨术中的应用. 中华骨科杂志, 2015, 35(4): 349-356.
5. Hyun SJ, Lenke LG, Kim YC, et al. Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976), 2014, 39(22): 1899-1904.
6. Denis F, Sun EC, Winter RB. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976), 2009, 34(20): E729-E734.
7. Kim HJ, Lenke LG, Shaffrey CI, et al. Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review. Spine (Phila Pa 1976), 2012, 37(22 Suppl): S144-S164.
8. Liu H, Yang C, Zheng Z, et al. Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. Spine (Phila Pa 1976), 2015, 40(8): 570-579.
9. Takenaka S, Mukai Y, Hosono N, et al. Major surgical treatment of osteoporotic vertebral fractures in the elderly: a comparison of anterior spinal fusion, anterior-posterior combined surgery and posterior closing wedge osteotomy. Asian Spine J, 2014, 8(3): 322-330.
10. Demirkiran G, Dede O, Karadeniz E, et al. Anterior and posterior vertebral column resection versus posterior-only technique: a comparison of clinical outcomes and complications in congenital kyphoscoliosis. Clin Spine Surg, 2017, 30(7): 285-290.
11. 李玉伟, 王海蛟, 崔巍, 等. 保留后方韧带复合体的腰椎融合术远期疗效观察. 中国修复重建外科杂志, 2019, 33(1): 56-60.
12. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50.
13. 王翔宇, 谭伦, 林旭, 等. 光电导航引导单侧穿刺椎体后凸成形术治疗胸腰椎骨质疏松性椎体压缩骨折. 中国修复重建外科杂志, 2018, 32(2): 203-209.
14. Shi B, Zhao Q, Xu L, et al. SRS-Schwab Grade 4 osteotomy for congenital thoracolumbar kyphosis: a minimum of 2 years follow-up study. Spine J, 2018, 18(11): 2059-2064.
15. Liu FY, Zhao ZQ, Ren L, et al. Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures: Two case reports. Medicine (Baltimore), 2018, 97(52): e13846.
16. Jo DJ, Kim YS, Kim SM, et al. Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. J Neurosurg Spine, 2015, 23(4): 510-517.
17. Smith JS, Shaffrey CI, Ames CP, et al. Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery, 2012, 71(4): 862-867.
18. 汪飞, 邱勇, 钱邦平, 等. 后路全脊椎截骨治疗严重脊柱畸形内固定棒断裂危险因素分析. 中华骨科杂志, 2012, 32(10): 946-950.
19. Ataka H, Tanno T, Yamazaki M. Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J, 2009, 18(1): 69-76.
20. 李超, 于海洋, 付青松, 等. 后柱切除后伸压缩中柱矫治胸腰段骨质疏松性重度椎体压缩骨折伴后凸畸形. 中国脊柱脊髓杂志, 2013, 23(8): 700-705.