SRS-Schwab Ⅳ级截骨联合椎间融合器与单纯Ⅳ级截骨治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形的矫形及临床疗效比较。

Comparison of corrective and clinical effects between SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis.

机构信息

Department of Spine Surgery, Sichuan Provincial Orthopedic Hospital, Chengdu, China.

出版信息

Ann Palliat Med. 2022 Jan;11(1):272-280. doi: 10.21037/apm-21-3852.

DOI:10.21037/apm-21-3852

PMID:35144418

Abstract

BACKGROUND

To compare the corrective and clinical effects between Scoliosis Research Society (SRS)-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis.

METHODS

Twenty-four cases of old thoracolumbar osteoporotic fractures with kyphosis treated by grade IV osteotomy in Sichuan Provincial Orthopedic Hospital from January 2018 to December 2019 were reviewed. Eleven cases were treated with grade IV osteotomy combined with the interbody fusion cage (group A), and 13 cases were treated with grade IV osteotomy alone (group B). Operation time, blood loss, and perioperative conditions of the 2 groups were recorded. After operation and the last follow up, the kyphosis angle (Cobb angle) and sagittal vertical axis (SVA) were measured by whole-spine splicing X-ray; clinical effect was analyzed by visual analog score (VAS) and Oswestry disability index (ODI).

RESULTS

All operations were successful. Operation time was 239.5±29.0 min in group A and 179.2±22.7 min in group B (P<0.05). Intraoperative blood loss in group A was 1,560.9±378.6 mL and 1,242.3±339.0 mL in group B (P<0.05). Cerebrospinal fluid leakage occurred in 3 cases in group A and 1 case in group B (P<0.05). There were 3 cases of transient neurological symptoms in group A and 1 case in group B (P<0.05). There was no significant difference in Cobb angle and SVA between the 2 groups (P>0.05). There was no significant difference in ODI and VAS between the 2 groups (P>0.05). There were no complications, such as spinal cord injury, internal fixation loosening and fracture, or orthopedic loss.

CONCLUSIONS

SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy can achieve good short-term orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. Corrective and clinical effects of the two groups are equivalent, but the operation time of grade IV osteotomy combined with the interbody fusion cage is longer, the amount of intraoperative blood is greater, and the incidence of complications is higher.

摘要

背景

比较 Scoliosis Research Society (SRS)-Schwab 四级截骨术联合椎间融合 cage 与单纯四级截骨术治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形的矫形和临床效果。

方法

回顾性分析 2018 年 1 月至 2019 年 12 月四川省骨科医院采用四级截骨术治疗的 24 例陈旧性胸腰椎骨质疏松性骨折伴后凸畸形患者。其中 11 例采用四级截骨术联合椎间融合 cage 治疗（A 组），13 例采用单纯四级截骨术治疗（B 组）。记录两组手术时间、出血量及围手术期情况。术后及末次随访时，行全脊柱拼接 X 线摄片测量后凸角（Cobb 角）和矢状垂直轴（SVA）；采用视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）分析临床疗效。

结果

两组手术均顺利完成。A 组手术时间为 239.5±29.0 min，B 组为 179.2±22.7 min（P<0.05）。A 组术中出血量为 1560.9±378.6 mL，B 组为 1242.3±339.0 mL（P<0.05）。A 组术后发生脑脊液漏 3 例，B 组 1 例（P<0.05）。A 组术后一过性神经症状 3 例，B 组 1 例（P<0.05）。两组 Cobb 角和 SVA 比较差异均无统计学意义（P>0.05）。两组 ODI 和 VAS 比较差异均无统计学意义（P>0.05）。两组均无脊髓损伤、内固定松动及断裂、矫形丢失等并发症发生。