| Part One Study of limited posterior spine osteotomy in the treatment of ld vertebral compression fractures with kyphosisObjective: To investigate the clinical efficacy of posterior limited spine osteotomy in the treatment of old thoracolumbar compression fracture.Methods: The clinical and imaging data of 25 patients with old thoracolumbar compression fracture were retrospectively reviewed.All patients underwent limited posterior column osteotomy and vertebral fusion.The operative time,intraoperative blood loss,postoperative complications,and screw stability at the last follow-up in all patients were documented.The Cobb angle for kyphotic deformity and the sagittal balance of the spine(SVA)before surgery were compared with those at the last follow-up and 3 months after surgery.The clinical efficacy was evaluated by the visual analog scale(VAS)score,Oswestry dysfunction index(ODI),and Japanese Orthopaedic Association(JOA)scores before surgery and at the last follow-up and 3 months after surgery.The improvement of neurological function after surgery was evaluated by Frankel classification.Results: The mean Cobb angle,SVA,VAS score,JOA score,and ODI were 30.88±7.04°,34.12±4.68 mm,7.00±1.47,22.00±2.00,and 41.20±3.96,respectively.The average follow-up period was 24.84±1.31 months.The Frankel grade in 2 patients with neurological impairment improved from D to E.The average Cobb angles for kyphotic deformity,SVA,VAS score,JOA score,and ODI were 7.96±2.34°,20.64±3.77 mm,2.64±1.29,27.72±0.94,and 13.20±3.69,3 months after surgery.At the last follow-up,mean Cobb Angle8.16±2.67°,mean SVA 20.40±3.79 mm,mean VAS score2.36±1.35,mean JOA score27.80±0.87,mean ODI 13.28±3.65.At 3 months and the last follow-up,there was significant improvement compared with that before surgery,and the difference was statistically significant.Conclusions: For patients with old thoracolumbar compression fracture,posterior limited spine osteotomy can improve patient quality of life to achieve good clinical efficacy.Part Two Modified unilateral posterior vertebral osteotomy for the treatment of severe congenital kyphosisObjective: To investigate the clinical efficacy of modified unilateral posterior vertebral column resection(MU-PVCR)in the treatment of severe congenital kyphoscoliosis..Methods: The clinical and imaging data of 22 patients with severe congenital kyphoscoliosis were retrospectively reviewed.All patients underwent MU-PVCR combined with spine pedicle screw-rod orthopaedics fixation and anterior column reconstruction.The operative time,intraoperative blood loss,postoperative complications,and screw stability at the last follow-up in all patients were documented.The Cobb angle for kyphotic deformity and the sagittal balance of the spine(SVA)before surgery were compared with those at the last follow-up and 3 months after surgery.The clinical efficacy was evaluated by the visual analog scale(VAS)score,Oswestry dysfunction index(ODI),and Japanese Orthopaedic Association(JOA)scores before surgery and at the last follow-up and one week after surgery.The improvement of neurological function after surgery was evaluated by Frankel classification.Results: The mean Cob angle,SVA,VAS score,JOA score,and ODI were 86.55±18.07°,51.32±8.18 mm,5.82±1.35,21.18±1.87,and 11.50±2.04 respectively.The average follow-up period was 26.14 ±1.55 months.The Frankel grade in 6 patients with neurological impairment improved from D to E.The average Cobb angles for kyphotic deformity,SVA,VAS score,JOA score,and ODI were39.86±9.13°,30.86±4.98 mm,2.09±1.11,27.36±1.09,and 2.77±0.87,3 months after surgery.At the last follow-up,mean Cobb Angle 39.50±9.89°,mean SVA 30.64±4.33 mm,mean VAS score 1.86±0.83,mean JOA score27.41±1.09,mean ODI 2.41±0.73.At 3 months and the last follow-up,there was significant improvement compared with that before surgery,and the difference was statistically significant.Conclusions: For patients with severe congenital kyphoscoliosis,MU-PVCR can improve patient quality of life to achieve good clinical efficacy.Part Three Posterior vertebral column resection combined with bone ement augmentation of pedicle screw fixation for treatment of severe vertebral compression fractures with yphotic deformityObjective: To investigate the clinical efficacy of posterior vertebral column resection(PVCR)combined with bone cement augmentation of pedicle screw fixation in the treatment of severe vertebral compression fractures with kyphotic deformity.Methods: The clinical and imaging data of 26 patients with evere vertebral compression fractures with kyphotic deformity were retrospectively reviewed.All patients underwent PVCR combined with bone cement augmentation of pedicle screw fixation and anterior column reconstruction.The operative time,intraoperative blood loss,postoperative complications,and screw stability at the last follow-up in all patients were documented.The Cobb angle for kyphotic deformity and the sagittal balance of the spine(SVA)before surgery were compared with those at the last follow-up after surgery.The clinical efficacy was evaluated by the visual analog scale(VAS)score,Oswestry dysfunction index(ODI),and Japanese Orthopaedic Association(JOA)scores before surgery and at the last follow-up.The improvement of neurological function after surgery was evaluated by Frankel classification.Results: The mean Cobb angle,SVA,VAS score,JOA score,and ODI were 48.55°±6.91°,44.02±5.73,6.53±1.51,11.26±2.72,and 59.02±5.71 before surgery,respectively.The average follow-up period was 24.34 ±2.15 months.The Frankel grade in five patients with neurological impairment improved from D to E after surgery.The average Cobb angles for kyphotic deformity,SVA,VAS score,JOA score,and ODI were 9.53°±3.82°,18.35±3.51,2.65±1.21,20.56±3.63,and 20.78±4.01 at the last follow-up,respectively,(all P<0.05 compared with before surgery).Conclusions: For patients with severe vertebral compression fractures and kyphotic deformity,PVCR combined with bone cement augmentation of pedicle screw fixation can restore the spine sequence to achieve good clinical efficacy.Clinical trials are necessary for confirmation. |
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