Li Xiang, Zhang Junwei, Tang Hehu, Lu Zhen, Chen Shizheng, Hong Yi
School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China.
Department of Spine Surgery, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China.
Eur J Med Res. 2014 Nov 1;19(1):59. doi: 10.1186/s40001-014-0059-3.
Surgical treatment modalities for post-traumatic kyphosis (PTK) remain controversial. Like vertebral column resection, closing-opening wedge osteotomy (COWO) can achieve satisfactory results for kyphosis with multiple etiologies. However, few studies have assessed this procedure for PTK. Our purpose was to evaluate the radiographic and clinical outcomes of COWO in a selected series of patients with PTK via a single posterior approach.
In this retrospective case series, seven patients with symptomatic PTK in the thoracolumbar spine were reviewed. Five patients underwent surgery at the time of initial injury, and the other two initially underwent conservative treatment. All seven patients underwent COWO procedures through a single posterior approach. The Cobb angle was assessed preoperatively, postoperatively, and at the final follow-up. A visual analog scale (VAS) and the American Spinal Injury Association scale were used to evaluate back pain and neurological function preoperatively and at final follow-up, respectively. Operation-associated complications were also recorded.
The mean follow-up period was 34.3 months (range, 24 to 43 months). The mean kyphotic angle was significantly (P <0.05) reduced from 57.7° (range, 36° to 100°) preoperatively to 8° postoperatively (range, -12° to 50°). The mean VAS improved from 5.9 to 2.1 (P <0.05). Three patients exhibited improved neurological function. Bony fusion was achieved in all patients. No significant correction loss or permanent complication was noted.
Though technically demanding, COWO via a single posterior approach can provide satisfactory outcomes for selected patients with PTK. Additional studies are required to improve patient selection and outcomes for this condition.
创伤后脊柱后凸（PTK）的手术治疗方式仍存在争议。与脊柱椎体切除术一样，闭合-开放楔形截骨术（COWO）对于多种病因导致的脊柱后凸可取得满意效果。然而，很少有研究评估该手术用于PTK的情况。我们的目的是通过单一后路入路，评估COWO在一组选定的PTK患者中的影像学和临床结果。
在这个回顾性病例系列中，对7例胸腰椎有症状的PTK患者进行了评估。5例患者在初次受伤时接受了手术，另外2例最初接受了保守治疗。所有7例患者均通过单一后路入路进行了COWO手术。术前、术后及末次随访时评估Cobb角。术前和末次随访时分别使用视觉模拟量表（VAS）和美国脊髓损伤协会量表评估背痛和神经功能。还记录了手术相关并发症。
平均随访期为34.3个月（范围24至43个月）。平均后凸角从术前的57.7°（范围36°至100°）显著（P<0.05）降至术后的8°（范围-12°至50°）。平均VAS从5.9改善至2.1（P<0.05）。3例患者神经功能得到改善。所有患者均实现了骨性融合。未发现明显的矫正丢失或永久性并发症。
尽管技术要求较高，但通过单一后路入路的COWO可为选定的PTK患者提供满意的结果。需要进一步研究以改善这种情况下的患者选择和治疗效果。
