Niu Xingbang, Zhang Haiping, He Simin, Huang Yansheng, Zhu Ziqi, Shi Shaoyan, Hao Dingjun
Xi'an Medical University, Xi'an Shaanxi, 710068, P. R. China.
Department of Spinal Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Sep 8;30(9):1118-1121. doi: 10.7507/1002-1892.20160227.
To investigate the clinical efficacy and the indications of posterolateral fusion and pedicle screw short-segment fixation via injured vertebra for treating old thoracolumbar fracture combined with kyphosis in elderly patients.
Between January 2012 and December 2014, 24 patients with old thoracolumbar fracture and kyphosis received posterolateral fusion and pedicle screw short-segment fixation via injured vertebra. Of 24 cases, 8 were male and 16 were female with an average age of 66.3 years (range, 56-79 years). The mean disease course was 17.5 months (range, 5-36 months). There were 13 cases of osteoporosis, 9 cases of osteopenia, and 2 cases of normal bone. The visual analogue scale (VAS) was 6.53±0.95, and Oswestry disability index (ODI) was 52.63%±5.74% preoperatively. The thoracolumbar kyphosis located at T to L, and the kyphotic Cobb angle was (28.79±5.04)° before operation.
The operation was completed successfully without related complications. The operative time was 1.2-2.3 hours (mean, 1.6 hours), and intraoperative blood loss was 80-210 mL (mean, 158 mL). No nerve injury occurred. Poor healing of incision was observed in 1 patient with diabetes, and primary healing of incision was obtained in the other patients. Nineteen patients were followed up 6-30 months (mean, 14.4 months), and there were 2 deaths. Pain relief and function recovery were obtained in 19 patients after operation. The VAS score and ODI were significantly decreased to 2.4±0.7 and 32.14%±5.12% at last follow-up (=8.542, =0.000; =9.826, =0.000). The kyphotic Cobb angle was significantly decreased to (21.23±4.30)° at immediate after operation (<0.05) and to (23.68±4.35)° at last follow-up (<0.05), but no significant difference was found between at immediate and last follow-up (>0.05). No loosening or breakage of internal fixation was observed during follow-up.
Posterolateral fusion and pedicle screw short-segment fixation via injured vertebra is a safe and effective treatment for elderly patients with old thoracolumbar fracture combined with kyphosis (Cobb angle less than 40°).
探讨经伤椎椎弓根螺钉短节段固定联合后外侧融合术治疗老年陈旧性胸腰椎骨折伴后凸畸形的临床疗效及适应证。
2012年1月至2014年12月，对24例陈旧性胸腰椎骨折伴后凸畸形患者行经伤椎椎弓根螺钉短节段固定联合后外侧融合术。24例患者中，男8例，女16例，平均年龄66.3岁（56～79岁）。平均病程17.5个月（5～36个月）。骨质疏松13例，骨量减少9例，骨质正常2例。术前视觉模拟评分（VAS）为6.53±0.95，Oswestry功能障碍指数（ODI）为52.63%±5.74%。胸腰段后凸畸形位于T～L，术前Cobb角为（28.79±5.04）°。
手术均顺利完成，无相关并发症发生。手术时间1.2～2.3小时（平均1.6小时），术中出血量80～210ml（平均158ml）。无神经损伤发生。1例糖尿病患者切口愈合欠佳，其余患者切口均一期愈合。19例患者获随访6～30个月（平均14.4个月），死亡2例。术后19例患者疼痛缓解，功能恢复。末次随访时VAS评分及ODI分别显著降至2.4±0.7和32.14%±5.12%（=8.542，=0.000；=9.826，=0.000）。术后即刻Cobb角显著降至（21.23±4.30）°（<0.05），末次随访时降至（23.68±4.35）°（<0.05），但术后即刻与末次随访时比较差异无统计学意义（>0.05）。随访期间内固定无松动、断裂。
经伤椎椎弓根螺钉短节段固定联合后外侧融合术是治疗老年陈旧性胸腰椎骨折伴后凸畸形（Cobb角小于40°）的一种安全、有效的方法。
