目的 探讨多节段Ponte截骨联合骨水泥强化治疗胸腰段陈旧性骨质疏松骨折并后凸畸形的手术方法及疗效. 方法 回顾性研究近五年我科收治的24例胸腰段陈旧性骨质疏松骨折并后凸畸形伴有顽固性下腰痛的骨质疏松患者的临床资料,测定骨密度并判断骨质疏松情况,均行后路多节段Ponte截骨联合骨水泥强化三维矫形植骨内固定术.对比分析手术前后影像学数据,随访时采用Oswestry功能障碍指数问卷表(ODI)进行评价. 结果 所有患者使用椎弓根钉8～10枚,关键椎采用骨水泥强化椎弓根钉,平均6.5枚/例;手术时间平均158(125 ～ 200)min,出血量平均356(200～560) ml.术后脑脊液漏6例,经处理后愈合良好.所有患者均无椎弓根钉拔钉、断钉,无神经损伤、伤口感染及骨水泥漏致栓塞病等严重并发症.本组均获随访,随访时间2 ～2.5年.术后即刻胸腰段后凸较术前平均矫正率为71.85％,未次(2～2.5年)随访平均矫正率分别为71.43％,随访期的矫正率均较术前明显改善,差异有统计学意义(P＜0.05),术后1月、6月及术后1年、2年胸腰段后凸Cobb角、腰痛ODI评分与术前比较均改善明显,差异均有统计学意义(P＜0.05),但术后各时期之间后凸Cobb角间比较无统计学差异(P＞0.05),末次随访ODI评分与术后即刻及1月相比差异有统计学意义(P＜0.05),与术后6月及1年比较差异无统计学意义(P＞0.05). 结论 多节段Ponte截骨联合骨水泥强化治疗胸腰段陈旧性骨质疏松骨折并后凸畸形适用于后凸Cobb角＜50°、最大单个椎体压缩比＜0.70的老年骨质疏松性患者,可以达到良好的矫正效果,改善顽固性下腰痛,手术时间短、出血少,无严重并发症,是一种安全有效的手术方式.%Objective To explore the operative technique and effect of multiple segment Ponte osteotomy combined with augmented bone cement in the treatment of old osteoporotic vertebra compressed fracture (OVCF) and kyphosis of thoracolumbar vertebrae.Methods The clinical data of 24 cases from our department in recent 5 years who suffered intractable back pain caused by old OVCF and thoracolumbar kyphosis were analyzed retrospectively.All cases were treated by multiple segmental Ponte osteotomy combined with augmented bone cement after preoperative bone mineral density measurement.Results The average numbers of augmented bone cement pedicle screw was 6.5,the average operative duration was 158(ranged 125 ～ 200) min and the average blood loss was 356 (ranged 200 ～560)ml.The cerebrospinal leak was found in 6 cases and cured by treatment.No serious postoperative complications occurred as looseness and broken of screws,injury of nerve,wound infection and bone cement leakage.All cases were followed up from 2 to 2.5 years.The average correcting ratio of screw thoracolumbar kyphosis was 71.85％ after the surgery,the corrective rate of last time follow-up was 71.43％,and there was no statistical difference between them (P ＞ 0.05).The corrective rates were improved obviously during the follow-up period than pre-operation,and the differences were statistically significant (P ＜ 0.05).The postoperative Cobb's angle of thoracolumbar kyphosis and ODI scores of low back pain were improved obviously than that of pre-operation in all 24 cases,the differences were statistically (P ＜ 0.05).The Cobb angle of thoracolumbar kyphosis had no statistical differences in different time points (1-,6-moths,1-and 2 year) after the surgery (P ＞ 0.05).The ODI score of the final follow-up (2-year after the surgery) was remarkable lower than that of both instant and 1-month after the surgery (P ＜ 0.05),but no statistical differences among the final follow-up and 6-months and 1-year after the surgery (P ＞ 0.05).Conclusions Multiple segment Ponte osteotomy combined with augmented bone cement is suitable for old OVCF and thoracolumbar kyphosis patients with the Cobb's angle of thoracolumbar kyphosis ＜ 50° and the largest compression ratio of single vertebrae ＜ 0.70.It can achieve good correction,improve the intractable back pain,and is a safe and effective surgical procedure with short operative time,less bleeding and no serious complications.
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