Ponte OSTEOTOMY FOR OLD OSTEOPOROTIC MULTI-SEGMENT VERTEBRAL FRACTURE COMBINED WITH THORACOLUMBAR KYPHOSIS IN ELDERLY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CUILiqiang ,  XIEShiming , PENGWusi , CHENYulong , XUJianfeng , CAOYun , LIUYunjie , QINGPeidong

Department of Spinal Surgery, Mianyang Orthopedic Hospital, Mianyang Sichuan, 621000, P. R. China;

Corresponding author：

XIEShiming, Email: bonesos@163.com

Keywords：

Osteoporosis; Old fracture; Kyphosis; Ponte osteotomy

DOI：

10.7507/1002-1892.20150068

Video：

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Objective To investigate the clinical outcome of Ponte osteotomy for old osteoporotic multi-segment vertebral fracture combined with thoracolumbar kyphosis in elderly. Methods Between April 2007 and December 2012, 11 elderly patients with thoracolumbar kyphosis caused by old osteoporotic multi-segment vertebral fracture received Ponte osteotomy. There were 4 males and 7 females, with an average age of 69 years (range, 62-76 years) and with an average disease duration of 4 years (range, 10 months to 7 years). A total of 51 vertebrae was involved in fracture, including T₅ in 1, T₈ in 1, T₉ in 1, T₁₀ in 5, T₁₁ in 8, T₁₂ in 11, L₁ in 11, L₂ in 10, and L₃ in 3. Based on Frankel classification, there were 9 cases of grade E and 2 cases of grade D. The Cobb angle of thoracolumbar kyphosis and the distance of sagital plane between C₇ plump line and the posterior superior corner of S₁ (sagittal vertical axis distance, SVA) were measured at pre-operation, at 2 weeks after operation, and last follow-up. The effectiveness of the treatment was appraised by visual analogue scale (VAS). Results All the operations were successfully completed. Cerebrospinal fluid leakage occurred in 3 cases, and was cured after symptomatic treatment. Eleven patients were followed up 22 months on average (range, 7-38 months). Back pain symptoms, the appearance, and the trunk balance were significantly improved after operation. Postoperatively neurological symptoms were not aggravated. In 2 cases of grade D, 1 case recovered to grade E, and 1 case had no improvement. Osseous fusion was observed at 6.7 months on average (range, 5-9 months) in 10 patients except 1 patient who had no complete fusion at 7 months after operation. There was no infection, failure of internal fixation, or other complications. At 2 weeks after operation and last follow-up, the VAS score, Cobb angle, and SVA were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 2 weeks and last follow-up (P>0.05). The correction rate of Cobb angle was 70.6%±2.2% at 2 weeks after operation and was 66.7%±1.3% at last follow-up, showing no significant difference (t=25.20, P=0.13). Conclusion Ponte osteotomy is effective for old osteoporotic multi-segment vertebral fracture combined with thoracolumbar kyphosis in elderly. It can obtain satisfactory sagittal balance.

Citation： CUILiqiang, XIEShiming, PENGWusi, CHENYulong, XUJianfeng, CAOYun, LIUYunjie, QINGPeidong. Ponte OSTEOTOMY FOR OLD OSTEOPOROTIC MULTI-SEGMENT VERTEBRAL FRACTURE COMBINED WITH THORACOLUMBAR KYPHOSIS IN ELDERLY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 321-325. doi: 10.7507/1002-1892.20150068 Copy

1.	陈建梅, 姚晓东, 黄丽花, 等. 经后路椎弓根截骨内固定治疗老年严重脊柱后凸畸形. 临床骨科杂志, 2013, 16(4):365-367.
2.	徐冠华, 崔志明, 李卫东, 等. 后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形. 中国脊柱脊髓杂志, 2013, 23(2):129-134.
3.	蒋伟宇, 徐荣明, 马维虎, 等. 后路截骨矫形长节段固定治疗老年性胸腰段后凸畸形. 中国骨伤, 2012, 25(4):299-302.
4.	Geck MJ, Macagno A, Ponte A, et al. The Ponte procedure:posterior only treatment of Scheuermann's kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech, 2007, 20(8):586-593.
5.	Heini PF. Comment on "Transpedicle body augmenter in painful osteoporotic compression fractures". Eur Spine J, 2007, 16(5):599-600.
6.	邱明才. 骨质疏松研究的现状与展望. 中华医学杂志, 2001, 81(14):833-835.
7.	韦兴, 侯树勋, 史亚民, 等. 611例胸腰椎骨折患者的流行病学分析. 中国脊柱脊髓杂志, 2004, 14(7):403-405.
8.	Wong CC, McGirt MJ. Vertebral compression fractures:a review of current management and multimodal therapy. J Multidiscip Healthc, 2013, 6:205-214.
9.	唐永超, 梁德, 江晓兵, 等. 后路截骨联合钉道强化术治疗陈旧性骨质疏松性胸腰椎骨折并后凸畸形. 脊柱外科杂志, 2013, 11(5):269-273.
10.	Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11(3):214-226.
11.	栾方海, 韩建龙, 陈丽艳, 等. 骨质疏松性胸腰椎骨折的外科治疗进展. 中国矫形外科杂志, 2011, 19(22):1887-1889.
12.	杨惠林, Hansen A, 王根林, 等. Catheter fabric椎体后凸成形术的初步临床应用. 中华创伤骨科杂志, 2010, 12(2):105-108.
13.	张铭华, 李波, 郑华, 等. 后路椎间截骨矫形治疗胸腰椎陈旧骨折迟发后凸畸形的疗效观察. 第三军医大学学报, 2007, 29(16):1639.
14.	曾岩, 陈仲强, 郭昭庆, 等. 中-重度脊柱后凸成角畸形后路矫形手术的并发症及其对策. 中国脊柱脊髓杂志, 2011, 21(6):468-473.
15.	Kim HS, Lee SY, Nanda A, et al. Comparison of surgical outcomes in thoracolumbar fractures operated with posterior constructs having varying fixation length with selective anterior fusion. Yonsei Med J, 2009, 50(4):546-554.
16.	许子星, 许卫红, 王长昇, 等. 后路长节段固定联合椎体成形术治疗重度骨质疏松胸腰椎压缩骨折疗效观察. 中国修复重建外科杂志, 2013, 27(11):1331-1337.
17.	张国莹, 张永刚, 张雪松, 等. 特发性脊柱侧凸多节段Ponte截骨术对恢复胸椎后凸的疗效. 中国修复重建外科杂志, 2012, 26(10):1197-1201.
18.	刘祥胜, 朱晓东, 白玉树, 等. Ponte截骨与SPO截骨联合后路全椎弓根螺钉系统矫正僵硬性青少年特发性胸椎侧凸的疗效比较. 中国矫形外科杂志, 2012, 20(15):1350-1355.

1. 陈建梅, 姚晓东, 黄丽花, 等. 经后路椎弓根截骨内固定治疗老年严重脊柱后凸畸形. 临床骨科杂志, 2013, 16(4):365-367.
2. 徐冠华, 崔志明, 李卫东, 等. 后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形. 中国脊柱脊髓杂志, 2013, 23(2):129-134.
3. 蒋伟宇, 徐荣明, 马维虎, 等. 后路截骨矫形长节段固定治疗老年性胸腰段后凸畸形. 中国骨伤, 2012, 25(4):299-302.
4. Geck MJ, Macagno A, Ponte A, et al. The Ponte procedure:posterior only treatment of Scheuermann's kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech, 2007, 20(8):586-593.
5. Heini PF. Comment on "Transpedicle body augmenter in painful osteoporotic compression fractures". Eur Spine J, 2007, 16(5):599-600.
6. 邱明才. 骨质疏松研究的现状与展望. 中华医学杂志, 2001, 81(14):833-835.
7. 韦兴, 侯树勋, 史亚民, 等. 611例胸腰椎骨折患者的流行病学分析. 中国脊柱脊髓杂志, 2004, 14(7):403-405.
8. Wong CC, McGirt MJ. Vertebral compression fractures:a review of current management and multimodal therapy. J Multidiscip Healthc, 2013, 6:205-214.
9. 唐永超, 梁德, 江晓兵, 等. 后路截骨联合钉道强化术治疗陈旧性骨质疏松性胸腰椎骨折并后凸畸形. 脊柱外科杂志, 2013, 11(5):269-273.
10. Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11(3):214-226.
11. 栾方海, 韩建龙, 陈丽艳, 等. 骨质疏松性胸腰椎骨折的外科治疗进展. 中国矫形外科杂志, 2011, 19(22):1887-1889.
12. 杨惠林, Hansen A, 王根林, 等. Catheter fabric椎体后凸成形术的初步临床应用. 中华创伤骨科杂志, 2010, 12(2):105-108.
13. 张铭华, 李波, 郑华, 等. 后路椎间截骨矫形治疗胸腰椎陈旧骨折迟发后凸畸形的疗效观察. 第三军医大学学报, 2007, 29(16):1639.
14. 曾岩, 陈仲强, 郭昭庆, 等. 中-重度脊柱后凸成角畸形后路矫形手术的并发症及其对策. 中国脊柱脊髓杂志, 2011, 21(6):468-473.
15. Kim HS, Lee SY, Nanda A, et al. Comparison of surgical outcomes in thoracolumbar fractures operated with posterior constructs having varying fixation length with selective anterior fusion. Yonsei Med J, 2009, 50(4):546-554.
16. 许子星, 许卫红, 王长昇, 等. 后路长节段固定联合椎体成形术治疗重度骨质疏松胸腰椎压缩骨折疗效观察. 中国修复重建外科杂志, 2013, 27(11):1331-1337.
17. 张国莹, 张永刚, 张雪松, 等. 特发性脊柱侧凸多节段Ponte截骨术对恢复胸椎后凸的疗效. 中国修复重建外科杂志, 2012, 26(10):1197-1201.
18. 刘祥胜, 朱晓东, 白玉树, 等. Ponte截骨与SPO截骨联合后路全椎弓根螺钉系统矫正僵硬性青少年特发性胸椎侧凸的疗效比较. 中国矫形外科杂志, 2012, 20(15):1350-1355.

Chinese Journal of Reparative and Reconstructive Surgery

Ponte OSTEOTOMY FOR OLD OSTEOPOROTIC MULTI-SEGMENT VERTEBRAL FRACTURE COMBINED WITH THORACOLUMBAR KYPHOSIS IN ELDERLY

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