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.	陳建梅, 姚曉東, 黃麗花, 等. 經后路椎弓根截骨內固定治療老年嚴重脊柱后凸畸形. 臨床骨科雜志, 2013, 16(4):365-367.
2.	徐冠華, 崔志明, 李衛東, 等. 后路截骨矯形手術治療老年骨質疏松性陳舊胸腰椎骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(2):129-134.
3.	蔣偉宇, 徐榮明, 馬維虎, 等. 后路截骨矯形長節段固定治療老年性胸腰段后凸畸形. 中國骨傷, 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. 骨質疏松研究的現狀與展望. 中華醫學雜志, 2001, 81(14):833-835.
7.	韋興, 侯樹勛, 史亞民, 等. 611例胸腰椎骨折患者的流行病學分析. 中國脊柱脊髓雜志, 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, 江曉兵, 等. 后路截骨聯合釘道強化術治療陳舊性骨質疏松性胸腰椎骨折并后凸畸形. 脊柱外科雜志, 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.	欒方海, 韓建龍, 陳麗艷, 等. 骨質疏松性胸腰椎骨折的外科治療進展. 中國矯形外科雜志, 2011, 19(22):1887-1889.
12.	楊惠林, Hansen A, 王根林, 等. Catheter fabric椎體后凸成形術的初步臨床應用. 中華創傷骨科雜志, 2010, 12(2):105-108.
13.	張銘華, 李波, 鄭華, 等. 后路椎間截骨矯形治療胸腰椎陳舊骨折遲發后凸畸形的療效觀察. 第三軍醫大學學報, 2007, 29(16):1639.
14.	曾巖, 陳仲強, 郭昭慶, 等. 中-重度脊柱后凸成角畸形后路矯形手術的并發癥及其對策. 中國脊柱脊髓雜志, 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.	許子星, 許衛紅, 王長昇, 等. 后路長節段固定聯合椎體成形術治療重度骨質疏松胸腰椎壓縮骨折療效觀察. 中國修復重建外科雜志, 2013, 27(11):1331-1337.
17.	張國瑩, 張永剛, 張雪松, 等. 特發性脊柱側凸多節段Ponte截骨術對恢復胸椎后凸的療效. 中國修復重建外科雜志, 2012, 26(10):1197-1201.
18.	劉祥勝, 朱曉東, 白玉樹, 等. Ponte截骨與SPO截骨聯合后路全椎弓根螺釘系統矯正僵硬性青少年特發性胸椎側凸的療效比較. 中國矯形外科雜志, 2012, 20(15):1350-1355.

1. 陳建梅, 姚曉東, 黃麗花, 等. 經后路椎弓根截骨內固定治療老年嚴重脊柱后凸畸形. 臨床骨科雜志, 2013, 16(4):365-367.
2. 徐冠華, 崔志明, 李衛東, 等. 后路截骨矯形手術治療老年骨質疏松性陳舊胸腰椎骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(2):129-134.
3. 蔣偉宇, 徐榮明, 馬維虎, 等. 后路截骨矯形長節段固定治療老年性胸腰段后凸畸形. 中國骨傷, 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. 骨質疏松研究的現狀與展望. 中華醫學雜志, 2001, 81(14):833-835.
7. 韋興, 侯樹勛, 史亞民, 等. 611例胸腰椎骨折患者的流行病學分析. 中國脊柱脊髓雜志, 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, 江曉兵, 等. 后路截骨聯合釘道強化術治療陳舊性骨質疏松性胸腰椎骨折并后凸畸形. 脊柱外科雜志, 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. 欒方海, 韓建龍, 陳麗艷, 等. 骨質疏松性胸腰椎骨折的外科治療進展. 中國矯形外科雜志, 2011, 19(22):1887-1889.
12. 楊惠林, Hansen A, 王根林, 等. Catheter fabric椎體后凸成形術的初步臨床應用. 中華創傷骨科雜志, 2010, 12(2):105-108.
13. 張銘華, 李波, 鄭華, 等. 后路椎間截骨矯形治療胸腰椎陳舊骨折遲發后凸畸形的療效觀察. 第三軍醫大學學報, 2007, 29(16):1639.
14. 曾巖, 陳仲強, 郭昭慶, 等. 中-重度脊柱后凸成角畸形后路矯形手術的并發癥及其對策. 中國脊柱脊髓雜志, 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. 許子星, 許衛紅, 王長昇, 等. 后路長節段固定聯合椎體成形術治療重度骨質疏松胸腰椎壓縮骨折療效觀察. 中國修復重建外科雜志, 2013, 27(11):1331-1337.
17. 張國瑩, 張永剛, 張雪松, 等. 特發性脊柱側凸多節段Ponte截骨術對恢復胸椎后凸的療效. 中國修復重建外科雜志, 2012, 26(10):1197-1201.
18. 劉祥勝, 朱曉東, 白玉樹, 等. Ponte截骨與SPO截骨聯合后路全椎弓根螺釘系統矯正僵硬性青少年特發性胸椎側凸的療效比較. 中國矯形外科雜志, 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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