| ObjectiveThe aging social structure in China has led to a rising incidence of osteoporotic spinal fractures.Due to delayed treatment or improper iatrogenic treatment in some patients,the fracture becomes old and often accompanied by kyphosis of the spine,resulting in back pain,sagittal imbalance and even spinal cord nerve damage,which seriously affects daily life and requires surgical correction.With the rapid development of modern medical technology,reports of various types of orthopedic surgery applied to such patients have gradually increased.However,the disadvantages of different orthopedic methods include large surgical trauma,many postoperative complications and limited orthopedic effect.Based on this,the purpose of this study is to propose a new orthopedic technique-”transintervertebral release anterior-middle column bone impaction grafting posterior column compression closure orthopedics” to treat such patients and analyze the safety and preliminary effect of its clinical application.MethodsThe clinical data of 46 patients with senile osteoporotic fracture of the spine with kyphosis admitted to our department since March 2016 were reviewed.After screening by inclusion and exclusion criteria,the clinical data of 21 patients were selected.There were 1 male and 20 females;aged 55 to 75 years,with an average of 64.8 years,course of disease was 8 to 24 months,with an average of 13.1 months,bone mineral density T values were-3.4 to-2.1,with an average of-2.3;lesion segments: 17 cases of single segment,2 cases in T11,6 cases in T12,8 cases in L1,1 case in L2;4 cases of double segment,1 case in T11,121,2 cases in T12,L1,and 1 case in T12,L2 and preoperative neurological function was graded according to the American Spinal Injury Association(ASIA): 5 cases of grade D,16 cases of grade E.All patients underwent transintervertebral release anterior-middle column bone impaction grafting posterior column compression closure nail rod fixation orthopedics.Record the operation time,intraoperative blood loss,and surgical fixation segment of each patient.The clinical effect was evaluated by statistical analysis of visual analogue score(VAS)and Oswestry dysfunction index(ODI)recorded in the timeline of "preoperatively--3months after surgery--the last follow-up".The local kyphosis Cobb angle(LKCA),thoracic kyphosis(TK),and lumbar lordosis(LL)and sagitta lvertebral axis(SVA)to evaluate its orthopedic effect,and observe whether there are obvious orthopedic loss and complications such as loosening of internal fixation,fracture,and proximal junction kyphosis.ResultsAll the 21 patients included in the study completed the surgery successfully,with an average operation time of 193min(150 ? 260min).The mean intraoperative blood loss was 773 m L(400 ? 1200 m L).The intraoperative blood loss was 400 to 1200 m L,with an average of 773 m L.The intraoperative fixed segment was 4 to 9 with an average of 6.8.None of the patients were lost to follow-up,and the average follow-up time was 17.9 months(13-22 months).During the follow-up,based on the X-rays of thespine and the 3D CT reconstruction of the spine,no complications related to proximal junction kyphosis and internal fixation damage occurred.The LKCA,TK and SVA were significantly improved at 1 week and the last follow-up(P < 0.05).There was no significant difference between 1 week and the last follow-up(P > 0.05),with the F value of 173.058,14.364 and 7.577,respectively.And the LL was no statistically significant difference between different time points before and after surgery(F=3.013,P=0.057).The VAS score and ODI score were significantly improved at 3 months after operation and at the last follow-up,and further improved at the last follow-up than at 3months after operation.The differences between the time points were statistically significant(P < 0.05)and the F values were 816.271 and 182.116,respectively.Five patients with Asia grade D neurological function recovered to e grade at 6 months follow-up.ConclusionThe transintervertebral release anterior-middle column bone impaction grafting posterior column compression closure orthopedic for treating old osteoporotic vertebral fracture combined spinal kyphosis has definite effectiveness.Intraoperative operation is relatively simple,strong orthopedic ability,small intraoperative trauma,high surgical safety,accurate bone graft fusion and fewer postoperative complications.The application of this technique can effectively restore the sagittal balance and spinal nerve function of the patient's body,relieve back pain,improve quality of life,and is conducive to promotion at all levels of hospitals.It has good clinical application prospects. |
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