Effect Of Modified SRS-Schwab Grade Ⅳ Osteotomy On Digestive Function And Related Factors In The Treatment Of Osteoporotic Thoracolumbar Fractures With Kyphosi

Objective:To investigate the changes of digestive function in patients with osteoporotic thoracolumbar fracture with kyphosis treated by modified SRS-Schwab gradeⅣosteotomy,and to analyze the influencing factors of digestive function changes.Methods:The clinical data of 42 patients with osteoporotic thoracolumbar fracture with kyphosis treated with retrograde SRS-Schwab osteotomy from January 2019 to December 2021 in Sichuan Orthopedics Hospital were analyzed,including 22males and 20 females.The patients ranged in age from 52 to 75years(64.19±7.79 years)and were followed up for 14 to 20 months(16.68±2.24months).The functional digestive disorders quality of life questionnaire(FDDQL)and Gastrointestinal Symptom Rating scale(GSRS)were used to evaluate the digestive function,and the difference between preoperative and last follow-up(d FDDQL and d GSRS)were calculated.Pain and dysfunction were assessed using the visual analogue scale and Oswestry disability index.The difference between preoperative and last follow-up(d VAS,d ODI)was calculated.focal kyphosis(FK)was measured on full-length lateral radiographs of the standing spine before and at the last follow-up,and the correction rate was calculated.The projected area of the abdominal sagittal plane was measured on full-length lateral radiographs of the standing spine before and after the last follow-up,and the difference before and after the operation was calculated.Paired sample t test was used to analyze the difference of the above results between the preoperative and the last follow-up.Pearson correlation analysis and multifactor linear regression were used to analyze the related factors affecting the changes of digestive function after osteotomy and orthosis.Results:All patients were operated successfully without serious complications.At the last follow-up,FDDQL score of digestive function increased from 74.62 to 88.04(P<0.001),and GSRS score decreased from 36.84 to 20.48(P<0.001).At the last follow-up,the VAS score of low back pain decreased from 7.58 to 1.42(P<0.001)and the ODI decreased from 79.84%to 18.09%(P<0.001).At the last follow-up,FK decreased from 46.01°to 7.68°(P<0.001),and the sagittal surface area of the upper abdomen on full-length lateral radiographs of the standing spine increased from142.54 cm2 to 210.20 cm~2(P<0.001).Pearson correlation analysis showed that d FDDQL was positively correlated with the correction rate of kyphosis,the difference of abdominal sagittal surface area on lateral X-ray of the standing spine before and after surgery,d VAS and d ODI(r=0.542,P=0.001;r=0.738,P=0.001;r=0.572,P<0.001;r=0.416,P=0.013);The score of d GSRS was positively correlated with the correction rate of kyphosis,the difference of sagittal surface area of the abdomen on full-length lateral radiographs of the standing spine before and after surgery,d VAS and d ODI(r=0.623,P<0.001;r=0.772,P<0.001;r=0.764,P<0.001;r=0.532,P=0.001).Multifactor linear regression analysis showed that the difference of sagittal area of upper abdomen,VAS score,ODI score and kyphotic correction rate of full-length and lateral spinal X-ray before and after surgery were influencing factors for the improvement of FDDQL and GSRS scores of postoperative digestive function(b>0,P<0.05).Conclusions:Modified SRS-Schwab Grade IV osteotomy can improve digestive dysfunction in patients with osteoporotic thoracolumbar fracture and kyphosis.The improvement of digestive function is closely related to the reduction of lumbar and back pain,the increase of abdominal volume and the recovery of spinal functional activities,and the correction of kyphosis is the root cause.