多节段腰椎后路椎体间及后外侧融合椎弓根螺钉内固定治疗老年骨质疏松骨折合并胸腰椎后凸畸形
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摘要
背景:随着中国人口老龄化程度不断加重,骨质疏松性骨折合并后凸畸形发病率逐渐增高。对该病的手术方式是否需要截骨矫形尚存在争议。目的:探讨多节段腰椎后路椎体间融合及后外侧融合椎弓根螺钉内固定矫形对老年骨质疏松骨折合并胸腰椎后凸畸形患者的临床疗效和矢状位平衡的改善情况。方法:回顾性研究共纳入90例老年骨质疏松的患者,其中手术组40例为合并胸腰段后凸畸形的患者,在抗骨质疏松治疗基础上,通过多节段腰椎后路椎体间融合及后外侧融合椎弓根螺钉内固定进行矫形;非手术组50例存在骨质疏松,但无后凸畸形。通过对患者术前和术后随访,观察手术组Oswestry功能障碍指数、目测类比评分变化;对比2组间脊柱骨盆矢状位参数如胸椎后凸角、腰椎前凸角、矢状面躯干偏移、骨盆倾斜角和骨盆入射角,评估患者矢状面平衡的改善;通过日本骨质疏松生活质量评分对患者的生活质量进行评估。结果与结论:(1)手术组患者术后目测类比评分,Oswestry功能障碍指数均较术前明显改善;(2)手术组术后胸椎后凸角、矢状面躯干偏移和骨盆倾斜角均较术前明显改善;(3)生活质量方面,手术组术后姿势和形态评分、恐惧和心理评分较术前有明显改善,但仍低于非手术组(P <0.05);手术组术后的疼痛评分、一般健康评分与非手术组之间差异无显著性意义(P> 0.05);(4)通过多节段腰椎后路椎体间融合及后外侧融合椎弓根螺钉内固定矫形能有效改善老年骨质疏松合并胸腰椎后凸畸形患者的矢状面平衡,并提高患者的生活质量。
BACKGROUND: With aged trend of population in China becoming severe, the incidence of osteoporosis fracture with thoracolumbar kyphosis is increasing. Whether osteotomy is required or not still remains a controversy.OBJECTIVE: To evaluate the clinical efficacy and improvement in sagittal vertical axis after multiple posterior lumber interbody fusion and posterolateral fusion instrumentation for patients with osteoporotic fracture with thoracolumbar kyphosis.METHODS: Totally 90 cases of senile osteoporosis were included in the retrospective study. Operation group included 40 patients suffering osteoporosis and thoracolumbar kyphosis who underwent anti-osteoporosis treatment and multilevel posterior lumbar interbody fusion and posterolateral fusion instrumentation. Control group included 50 patients with osteoporotic without kyphosis. The Oswestry Disability Index and Visual Analogue Scale scores were compared between two groups after follow-up. Spinoplevic parameters, such as thoracic kyphosis angle, lumbar lordosis angle, sagittal vertical axis, pelvic title and pelvic incidence were compared to evaluate the improvement in the sagittal vertical axis. The quality of life was evaluated with the Japanese Osteoporosis Quality of Life Questionnaire scores.RESULTS AND CONCLUSION:(1) The Visual Analogue Scale and Oswestry Disability Index scores in the operation group were improved significantly compared the baseline.(2) The postoperative thoracic kyphosis angle, sagittal vertical axis, and pelvic title in the operation group were significantly improved compared with the baseline.(3) The postoperative posture, figure scores, and fear and physiological scores in the operation group were significantly improved compared with the baseline, but lower than those in the control group(P < 0.05). There were no significant differences in the pain and health scores between two groups postoperatively(P > 0.05).(4) These results indicate that spinal alignment and quality of life are significantly improved after corrective spinal surgery using multilevel posterior lumber interbody fusion and posterolateral fusion for patients with osteoporosis and thoracolumbar kyphosis.
BACKGROUND: With aged trend of population in China becoming severe, the incidence of osteoporosis fracture with thoracolumbar kyphosis is increasing. Whether osteotomy is required or not still remains a controversy.OBJECTIVE: To evaluate the clinical efficacy and improvement in sagittal vertical axis after multiple posterior lumber interbody fusion and posterolateral fusion instrumentation for patients with osteoporotic fracture with thoracolumbar kyphosis.METHODS: Totally 90 cases of senile osteoporosis were included in the retrospective study. Operation group included 40 patients suffering osteoporosis and thoracolumbar kyphosis who underwent anti-osteoporosis treatment and multilevel posterior lumbar interbody fusion and posterolateral fusion instrumentation. Control group included 50 patients with osteoporotic without kyphosis. The Oswestry Disability Index and Visual Analogue Scale scores were compared between two groups after follow-up. Spinoplevic parameters, such as thoracic kyphosis angle, lumbar lordosis angle, sagittal vertical axis, pelvic title and pelvic incidence were compared to evaluate the improvement in the sagittal vertical axis. The quality of life was evaluated with the Japanese Osteoporosis Quality of Life Questionnaire scores.RESULTS AND CONCLUSION:(1) The Visual Analogue Scale and Oswestry Disability Index scores in the operation group were improved significantly compared the baseline.(2) The postoperative thoracic kyphosis angle, sagittal vertical axis, and pelvic title in the operation group were significantly improved compared with the baseline.(3) The postoperative posture, figure scores, and fear and physiological scores in the operation group were significantly improved compared with the baseline, but lower than those in the control group(P < 0.05). There were no significant differences in the pain and health scores between two groups postoperatively(P > 0.05).(4) These results indicate that spinal alignment and quality of life are significantly improved after corrective spinal surgery using multilevel posterior lumber interbody fusion and posterolateral fusion for patients with osteoporosis and thoracolumbar kyphosis.
引文
[1]Wei Y,Tian W,Zhang GL,et al.Thoracolumbar kyphosis is associated with compressive vertebral fracture in postmenopausal women.Osteoporos Int.2017;28(6):1925-1929.
[2]王琨,杨操,杨述华,等.陈旧性胸腰椎骨折伴后凸畸形的截骨矫形术式选择[J].中国脊柱脊髓杂志,2016,26(1):24-29.
[3]Endo N.Which questionnaire is suitable for the QOLevaluation of osteoporotic patiemts?JOQOL is osteoporosis-targeted.Clin Calcium.2012;22(2):254-258.
[4]罗文正,唐廷波,陈诚.老年骨质疏松性脊柱骨折的临床特点与治疗方法选择[J].中国骨质疏松杂志,2012,18(7):647-649.
[5]邓红平,陈其昕,胡灏,等.经椎弓根椎体内植骨治疗老年骨质疏松性脊柱骨折的疗效分析[J].中国老年学杂志,2013,33(14):3322-3324.
[6]Barrey C,Roussouly P,Perrin G,et al.Sagittal balance disorders in severe degenerative spine.Can we identify the compensatory mechanisms?Eur Spine J.2011;20 Suppl 5:626-633.
[7]Chen P,Miller PD,Binkley NC,et al.Use of lowest single lumbar spine vertebra bone mineral density T-score and other T-score approaches for diagnosing osteoporosis and relationships with vertebral fracture status.J Clin Densitom.2008;11(4):525-531.
[8]Abdel-Hamid OA,Bassiouni H,Koutri R,et al.Aging of the thoracic spine:distinction between wedging in osteoarthritis and fracture in osteoporosis--a cross-sectional and longitudinal study.Bone.1994;15(4):437-442.
[9]Mika A,Unnithan VB,Mika P.Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis.Spine(Phila Pa 1976).2005;30(2):241-246.
[10]Buchowski JM,Kuhns CA,Bridwell KH,et al.Surgical management of posttraumatic thoracolumbar kyphosis.Spine J.2008;8(4):666-677.
[11]Bautmans I,Van Arken J,Van Mackelenberg M,et al.Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis.JRehabil Med.2010;42(2):129-135.
[12]Greig AM,Bennell KL,Briggs AM,et al.Balance impairment is related to vertebral fracture rather than thoracic kyphosis in individuals with osteoporosis.Osteoporos Int.2007;18(4):543-551.
[13]Sinaki M.Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine:case series.Pain Pract.2013;13(1):68-75.
[14]Wakao N,Takeuchi M,Kamiya M,et al.The surgical treatment method for an adult posttraumatic thoracolumbar kyphosis patient with osteogenesis imperfecta.Nagoya J Med Sci.2014;76(3-4):341-348.
[15]Dorward IG,Lenke LG.Osteotomies in the posterior-only treatment of complex adult spinal deformity:a comparative review.Neurosurg Focus.2010;28(3):E4.
[16]Heggeness MH.Spine fracture with neurological deficit in osteoporosis.Osteoporos Int.1993;3(4):215-221.
[17]Gokcay CA,Sain GG.Fracture of vertebral spine because of an unusual cause of osteoporosis in a young male patient.JClin Densitom.2012;15(2):255-256.
[18]Hansen-Algenstaedt N,Liem M,Holz J,et al.Posterior only approach to open wedge osteotomy in the thoracolumbar spine.Eur Spine J.2017.
[19]Sadatsune DA,Costa PP,Caffaro MF,et al.Thoracolumbar burst fracture:correlation between kyphosis and function after surgical treatment.Rev Bras Ortop.2012;47(4):474-478.
[20]张国华,陈宗成,张顾议,等.退变性腰椎侧后凸畸形的手术治疗[J].中国脊柱脊髓杂志,2007,17(7):489-493.
[21]Harrison RA,Siminoski K,Vethanayagam D,et al.Osteoporosis-related kyphosis and impairments in pulmonary function:a systematic review.J Bone Miner Res.2007;22(3):447-457.
[22]Hu X,Lieberman IH.Proximal instrumented vertebral body chance fracture after pedicle screw instrumentation in a thoracic kyphosis patient with osteoporosis.J Spinal Disord Tech.2015;28(1):31-36.
[2]王琨,杨操,杨述华,等.陈旧性胸腰椎骨折伴后凸畸形的截骨矫形术式选择[J].中国脊柱脊髓杂志,2016,26(1):24-29.
[3]Endo N.Which questionnaire is suitable for the QOLevaluation of osteoporotic patiemts?JOQOL is osteoporosis-targeted.Clin Calcium.2012;22(2):254-258.
[4]罗文正,唐廷波,陈诚.老年骨质疏松性脊柱骨折的临床特点与治疗方法选择[J].中国骨质疏松杂志,2012,18(7):647-649.
[5]邓红平,陈其昕,胡灏,等.经椎弓根椎体内植骨治疗老年骨质疏松性脊柱骨折的疗效分析[J].中国老年学杂志,2013,33(14):3322-3324.
[6]Barrey C,Roussouly P,Perrin G,et al.Sagittal balance disorders in severe degenerative spine.Can we identify the compensatory mechanisms?Eur Spine J.2011;20 Suppl 5:626-633.
[7]Chen P,Miller PD,Binkley NC,et al.Use of lowest single lumbar spine vertebra bone mineral density T-score and other T-score approaches for diagnosing osteoporosis and relationships with vertebral fracture status.J Clin Densitom.2008;11(4):525-531.
[8]Abdel-Hamid OA,Bassiouni H,Koutri R,et al.Aging of the thoracic spine:distinction between wedging in osteoarthritis and fracture in osteoporosis--a cross-sectional and longitudinal study.Bone.1994;15(4):437-442.
[9]Mika A,Unnithan VB,Mika P.Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis.Spine(Phila Pa 1976).2005;30(2):241-246.
[10]Buchowski JM,Kuhns CA,Bridwell KH,et al.Surgical management of posttraumatic thoracolumbar kyphosis.Spine J.2008;8(4):666-677.
[11]Bautmans I,Van Arken J,Van Mackelenberg M,et al.Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis.JRehabil Med.2010;42(2):129-135.
[12]Greig AM,Bennell KL,Briggs AM,et al.Balance impairment is related to vertebral fracture rather than thoracic kyphosis in individuals with osteoporosis.Osteoporos Int.2007;18(4):543-551.
[13]Sinaki M.Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine:case series.Pain Pract.2013;13(1):68-75.
[14]Wakao N,Takeuchi M,Kamiya M,et al.The surgical treatment method for an adult posttraumatic thoracolumbar kyphosis patient with osteogenesis imperfecta.Nagoya J Med Sci.2014;76(3-4):341-348.
[15]Dorward IG,Lenke LG.Osteotomies in the posterior-only treatment of complex adult spinal deformity:a comparative review.Neurosurg Focus.2010;28(3):E4.
[16]Heggeness MH.Spine fracture with neurological deficit in osteoporosis.Osteoporos Int.1993;3(4):215-221.
[17]Gokcay CA,Sain GG.Fracture of vertebral spine because of an unusual cause of osteoporosis in a young male patient.JClin Densitom.2012;15(2):255-256.
[18]Hansen-Algenstaedt N,Liem M,Holz J,et al.Posterior only approach to open wedge osteotomy in the thoracolumbar spine.Eur Spine J.2017.
[19]Sadatsune DA,Costa PP,Caffaro MF,et al.Thoracolumbar burst fracture:correlation between kyphosis and function after surgical treatment.Rev Bras Ortop.2012;47(4):474-478.
[20]张国华,陈宗成,张顾议,等.退变性腰椎侧后凸畸形的手术治疗[J].中国脊柱脊髓杂志,2007,17(7):489-493.
[21]Harrison RA,Siminoski K,Vethanayagam D,et al.Osteoporosis-related kyphosis and impairments in pulmonary function:a systematic review.J Bone Miner Res.2007;22(3):447-457.
[22]Hu X,Lieberman IH.Proximal instrumented vertebral body chance fracture after pedicle screw instrumentation in a thoracic kyphosis patient with osteoporosis.J Spinal Disord Tech.2015;28(1):31-36.