PSO联合SPO截骨与多段SPO截骨治疗外伤性胸腰椎后凸
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摘要
[目的]对比PSO联合SPO截骨与多节段SPO截骨术治疗胸腰椎陈旧骨折后凸畸形的疗效。[方法]2010年5月～2016年5月胸腰椎陈旧骨折后凸畸形患者36例在本科手术治疗,其中,19采用PSO+SPO截骨术,17例采用多节段SPO截骨术,两组患者术前一般资料差异无统计学意义(P>0.05)。比较两组围手术期资料、视觉模拟疼痛评分(VAS评分)、脊髓损伤Frankel分级,以及影像测量的TK、TLK、LL、SVA、PI、PT和SS。[结果]PSO+SPO截骨组有2例患者出现脑脊液漏,但未引起不良后果。两组其余患者无严重并发症。PSO+SPO截骨组手术时间及术中出血量均显著大于多节段SPO截骨组(P<0.05)。随访12～60个月。末次随访时,两组患者Frankel指数均较术前显著改善,但相应时间点两组间差异无统计学意义(P>0.05)。两组患者术后VAS评分均较术前显著减少(P<0.05),但相应时间点两组间差异均无统计学意义(P>0.05)。两组患者术后TK、TLK、LL、SVA、PT、SS与术前比较均有显著改善,差异均有统计学意义(P<0.05)。术后2周及末次随访时,PSO+SPO截骨组在TLK、LL、PT、SS矫正方面显著优于多节段SPO截骨组,差异有统计学意义(P<0.05)。[结论]两种术式均是治疗胸腰椎陈旧性骨折后凸畸形安全、有效的方法。但PSO联合SPO截骨术能获得更满意的矢状面平衡,却存在手术时间长、术中出血多等缺点。
[Objective] To compare the clinical outcomes of pedicle subtraction osteotomy(PSO) combined with Smith-Petersen osteotomy(SPO) versus multiple SPOs for thoracolumbar kyphosis deformity secondary to fractures. [Methods] From May2010 to May 2016, 36 patients underwent surgical treatment for traumatic thoracolumbar kyphosis in our department. Of them,19 patients received PSO combined with SPO, while the remaining 17 patients had multiple SPOs, with no statistically significant differences in preoperative general data between the two groups(P>0.05). The perioperative parameters, the visual analogue scale(VAS) for pain, Frankel grades of neurological function, and radiographic measurements, such as thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT)and sacral slope(SS), were compared between the two groups. [Results] Except that the cerebrospinal fluid leakage happened in 2 patients of the PSO+SPO group, which did not lead serious consequences after proper corresponding therapy, no severe complications occurred in any patient of both groups. The PSO+SPO group proved significantly longer operation time and more intraoperative blood loss than the multi-SPO group(P<0.05). The follow-up period lasted for 12-60 months. The Frankel grades of neurological function significantly improved at the latest follow up in both groups compared those before operation,nevertheless no a significant difference was found at any corresponding time point between the two groups. The VAS score significantly decreased after operation compared with that before operation in both group(P<0.05), although there was no a significant difference between the two groups at any matching time point(P>0.05). In term of radiographic measurements, the TK,TLK, LL, SVA, PT and SS significantly improved after operation compared with those preoperatively in both group(P<0.05), additionally, the PSO+SPO group proved significantly superior to the multi-SPO group regarding to TLK, LL, PT and SS at 2 weeks after operation and the latest follow-up(P<0.05).[Conclusion] Both PSO+SPO and multiple SPOs are effective and safe procedures for correction of thoracolumbar kyphosis secondary to old fractures. By contrast, the PSO+SPO procedure takes advantage of improved correction of deformity in sagittal plane, and disadvantage of prolonged operation time and more intraoperative blood loss over the multiple SPOs.
[Objective] To compare the clinical outcomes of pedicle subtraction osteotomy(PSO) combined with Smith-Petersen osteotomy(SPO) versus multiple SPOs for thoracolumbar kyphosis deformity secondary to fractures. [Methods] From May2010 to May 2016, 36 patients underwent surgical treatment for traumatic thoracolumbar kyphosis in our department. Of them,19 patients received PSO combined with SPO, while the remaining 17 patients had multiple SPOs, with no statistically significant differences in preoperative general data between the two groups(P>0.05). The perioperative parameters, the visual analogue scale(VAS) for pain, Frankel grades of neurological function, and radiographic measurements, such as thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT)and sacral slope(SS), were compared between the two groups. [Results] Except that the cerebrospinal fluid leakage happened in 2 patients of the PSO+SPO group, which did not lead serious consequences after proper corresponding therapy, no severe complications occurred in any patient of both groups. The PSO+SPO group proved significantly longer operation time and more intraoperative blood loss than the multi-SPO group(P<0.05). The follow-up period lasted for 12-60 months. The Frankel grades of neurological function significantly improved at the latest follow up in both groups compared those before operation,nevertheless no a significant difference was found at any corresponding time point between the two groups. The VAS score significantly decreased after operation compared with that before operation in both group(P<0.05), although there was no a significant difference between the two groups at any matching time point(P>0.05). In term of radiographic measurements, the TK,TLK, LL, SVA, PT and SS significantly improved after operation compared with those preoperatively in both group(P<0.05), additionally, the PSO+SPO group proved significantly superior to the multi-SPO group regarding to TLK, LL, PT and SS at 2 weeks after operation and the latest follow-up(P<0.05).[Conclusion] Both PSO+SPO and multiple SPOs are effective and safe procedures for correction of thoracolumbar kyphosis secondary to old fractures. By contrast, the PSO+SPO procedure takes advantage of improved correction of deformity in sagittal plane, and disadvantage of prolonged operation time and more intraoperative blood loss over the multiple SPOs.
引文
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[8]Lazennec JY,Neves N,Rousseau MA,et al.Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels[J].J Spinal Disord Tech,2006,19(7):487-494.
[9]Kawahara N,Tomita K,Baba H,et al.Closing-openingwedge oteotomy to correct angular kyphosis deformity by a single posterior approach[J].Spine,2001,26(4):391-402.
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[11]武兴国,李晓彬,郭建邦,等.PSO+SPO联合截骨术治疗胸腰椎后凸畸形[J/CD].中华临床医师杂志(电子版),2016,10(3):373-376.
[12]Hehne HJ,Zleike K,Bohm H.Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis report on 177 cases[J].Clin Orthop,1990(258):49-55.
[13]Vrtovec T,Janssen MM,Likar B,et al.A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment[J].Spine J,2012,12(5):433-446.
[14]Roussouly P,Nnadi C.Sagittal plane deformity:an overview of interpretation and management[J].Eur Spine J,2011,19(11):1824-1836.
[15]Gavaskar AS,Chowdary TN.Pedicle subtraction osteotomy for rigid kyphosis of the dorsolumbar spine[J].Arch Orthop Trauma Surg,2011,131(6):803-808.
[16]田浩,王辉,狄鹤轩,等.跳跃式双节段经椎弓根截骨长节段融合治疗强直性脊柱炎胸腰椎后凸畸形[J].中国脊柱脊髓杂志,2018,28(3):193-199.
[17]Kiaer T,Gehrchen M.Transpedicular closed wedge osteotomy in ankylosing spondylitis:results of surgical treatment and prospective outcome analysis[J].Eur Spine J,2010,19(1):57-64.
[2]Shin JK,Lee JS,Goh TS,et al.Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis[J].Eur Spine J,2014,23(1):242-247.
[3]Song K,Zheng G,Zhang Y,et al.A new method for calculation the exact angle required for spinal osteotomy[J].Spine,2013,38(10):E616-620.
[4]Roussouly P,Gollogly S,Berthonnaud E,et al.Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvi in the standing position[J].Spine,2005,30(3):346-353.
[5]Wang Y,Lenke LG.Vertebral column decancellation for the management of sharp angular spinal deformity[J].Eur Spine J,2011,20(10):1703-1710.
[6]Munting E.Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine:indications and technical aspects[J].Eur Spine J,2010,19(Suppl 1):69-73.
[7]Jain AK,Dhammi IK,Jain S,et al.Kyphosis in spinal tuberculosis-Prevention and correction[J].Indian J Orthop,2010,44(2):127-136.
[8]Lazennec JY,Neves N,Rousseau MA,et al.Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels[J].J Spinal Disord Tech,2006,19(7):487-494.
[9]Kawahara N,Tomita K,Baba H,et al.Closing-openingwedge oteotomy to correct angular kyphosis deformity by a single posterior approach[J].Spine,2001,26(4):391-402.
[10]Enercan M,Ozturk C,Kahraman S,et al.Osteotomies/spinal column resections in adult deformity[J].Eur Spine J,2013,22(2):254-264.
[11]武兴国,李晓彬,郭建邦,等.PSO+SPO联合截骨术治疗胸腰椎后凸畸形[J/CD].中华临床医师杂志(电子版),2016,10(3):373-376.
[12]Hehne HJ,Zleike K,Bohm H.Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis report on 177 cases[J].Clin Orthop,1990(258):49-55.
[13]Vrtovec T,Janssen MM,Likar B,et al.A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment[J].Spine J,2012,12(5):433-446.
[14]Roussouly P,Nnadi C.Sagittal plane deformity:an overview of interpretation and management[J].Eur Spine J,2011,19(11):1824-1836.
[15]Gavaskar AS,Chowdary TN.Pedicle subtraction osteotomy for rigid kyphosis of the dorsolumbar spine[J].Arch Orthop Trauma Surg,2011,131(6):803-808.
[16]田浩,王辉,狄鹤轩,等.跳跃式双节段经椎弓根截骨长节段融合治疗强直性脊柱炎胸腰椎后凸畸形[J].中国脊柱脊髓杂志,2018,28(3):193-199.
[17]Kiaer T,Gehrchen M.Transpedicular closed wedge osteotomy in ankylosing spondylitis:results of surgical treatment and prospective outcome analysis[J].Eur Spine J,2010,19(1):57-64.