Objective:

To investigate the effectiveness of trans-intervertebral space osteotomy (TIO) combined with cage implantation in treatment of old thoracolumbar compression fracture with kyphosis.

Methods:

A clinical data of 59 patients with old thoracolumbar compression fracture and kyphosis, who met the selection criteria between January 2010 and August 2020, was retrospectively analyzed. Among them, 20 cases underwent TIO combined with cage implantation (group A), 21 patients underwent TIO (group B), and 18 patients underwent pedicle subtraction osteotomy (PSO; group C). There was no significant difference in gender, age, time from injury to operation, fracture segment, and preoperative Cobb angle, average height of functional spinal unit (FSU), sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score, and Oswestry disability index (ODI) between groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications were recorded. Imaging review was performed to observe the fusion of the bone graft. Cobb angle, average height of FSU, and SVA were measured. VAS score, JOA score, and ODI were used to evaluate the degree of low back pain and lumbar function. Frankel grading was used to evaluate neurological function.

Results:

The operations of 3 groups were successfully completed. The operation time and intraoperative blood loss were significantly lower in groups A and B than in group C (P<0.05); there was no significant difference between group A and group B (P>0.05). All incisions healed by first intention. Patients in all groups were followed up 23-27 months, with an average of 24.8 months. There was no significant difference in follow-up time between groups (P>0.05). At last follow-up, VAS score, JOA score, ODI, and SVA of 3 groups significantly improved when compared with those before operation (P<0.05), there was no significant difference in the differences of pre- and post-operation between groups (P>0.05). The neurological function grading of 3 groups was Frankel grade E. The Cobb angle and the average height of FSU in 3 groups at immediate and last follow-up significantly improved when compared with preoperative ones (P<0.05), there was no significant difference between immediately after operation and last follow-up (P>0.05). And there were significant differences in above indexes between groups at each time point (P<0.05). At last follow-up, the osteotomy site fused without internal fixation failure or pseudarthrosis formation were observed in 3 groups.

Conclusion:

For patients with old thoracolumbar compression fractures with kyphosis, the effectiveness of TIO combined with cage implantation is satisfactory. Compared with TIO and PSO, it can obtain more deformity correction degree and less invasive.

目的:

探讨经椎间隙截骨（trans-intervertebral space osteotomy，TIO）联合椎间融合器（cage）植入治疗陈旧性胸腰椎压缩骨折伴后凸畸形的疗效。.

方法:

回顾分析2010年1月—2020年8月符合选择标准的59例陈旧性胸腰椎压缩骨折伴后凸畸形患者临床资料。其中20例接受TIO联合cage植入（A组），21例接受单纯TIO（B组），18例接受经椎弓根椎体截骨（pedicle subtraction osteotomy，PSO；C组）。3组患者性别、年龄、受伤至手术时间、骨折节段以及术前后凸Cobb角、脊柱矢状位平衡（sagittal vertical axis，SVA）、脊柱功能单位（functional spinal unit，FSU）平均高度、疼痛视觉模拟评分（VAS）、日本骨科协会（JOA）评分以及Oswestry功能障碍指数（ODI）比较，差异均无统计学意义（P>0.05）。记录手术时间、术中出血量及术后并发症发生情况；影像学复查观察植骨融合情况，测量后凸Cobb角、FSU平均高度、SVA；采用VAS评分、JOA评分以及ODI评价腰背痛程度及腰椎功能，Frankel分级评价神经功能。.

结果:

3组手术均顺利完成，A、B组手术时间及术中出血量均少于C组（P<0.05），A、B组间比较差异无统计学意义（P>0.05）。术后切口均Ⅰ期愈合。3组患者均获随访，随访时间23～27个月，平均24.8个月；随访时间组间差异无统计学意义（P>0.05）。末次随访时，3组VAS评分、JOA评分、ODI及SVA均较术前改善（P<0.05），上述指标手术前后差值组间差异均无统计学意义（P>0.05）；神经功能Frankel分级均达E级。3组术后即刻和末次随访时Cobb角、FSU平均高度均较术前改善（P<0.05），术后即刻与末次随访间差异无统计学意义（P>0.05）；各时间点3组组间差异均有统计学意义（P<0.05）。末次随访时，3组截骨区域均骨性融合，无内固定失败及假关节形成等并发症发生。.

结论:

对于陈旧性胸腰椎压缩骨折伴后凸畸形患者，采用TIO联合cage植入矫形效果满意，与单纯TIO 及PSO相比，可获得更大的畸形矫正程度且手术创伤小。.