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后路经椎间隙松解打压植骨后柱加压闭合矫形术治疗骨质疏松性脊柱骨折伴中重度后凸畸形

Treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis by transintervertebral release,bone impaction grafting,and posterior column compressed-closing
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摘要 目的探讨后路经椎间隙松解打压植骨、后柱加压闭合矫形术治疗骨质疏松性脊柱骨折伴中重度后凸畸形的安全性和初步临床效果。方法回顾性分析2016年3月-2017年11月收治的21例老年骨质疏松性脊柱骨折伴中重度后凸畸形患者临床资料。其中男1例,女20例;年龄55~75岁,平均64.8岁。病程8~24个月,平均13.1个月。骨密度T值为-3.4~-2.1,平均-2.3。病变节段:T11 2例,T12 6例,L1 8例,L2 1例,T11、12 1例,T12、L1 2例,T12、L2 1例。术前神经功能根据美国脊柱损伤协会(ASIA)分级:D级5例,E级16例。均行经椎间隙松解撑开打压植骨、后柱加压闭合矫形椎弓根螺钉内固定术。术前、术后3个月及末次随访时,采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价临床疗效;末次随访时采用ASIA分级评价神经功能。于术前、术后1周及末次随访时患者脊柱全长侧位X线片上测量局部后凸Cobb角(local kyphosis Cobb angle,LKCA)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)及矢状面平衡(sagittal vertebral axis,SVA)。结果患者手术时间150~260 min,平均193 min;术中出血量400~1 200 mL,平均773 mL;术中固定节段4~9个,平均6.8个。21例患者术后均获随访,随访时间13~22个月,平均17.9个月。无内固定物断裂、神经损伤等并发症发生。术后1周及末次随访时的LKCA、TK和SVA均较术前显著改善(P<0.05),术后1周和末次随访间差异无统计学意义(P>0.05);手术前后各时间点LL比较差异均无统计学意义(F=3.013,P=0.057)。术后3个月和末次随访时VAS评分和ODI评分均较术前显著改善,末次随访时较术后3个月进一步改善,各时间点间差异均有统计学意义(P<0.05)。5例术前神经功能ASIA分级D级患者术后6个月随访时恢复至E级。结论后路经椎间隙松解打压植骨、后柱加压闭合矫形术治疗骨质疏松性脊柱骨折伴中重度后凸畸形效果确切,矫形能力强且� Objective To explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis. Methods The clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from-3.4 to-2.1, with an average of-2.3. Lesion segments: T11 in 2 cases, T12 in 6 cases, L1 in 8 cases, L2 in 1 case, T11, 12 in 1 case, T12, L1 in 2 cases, and T12, L2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association(ASIA):5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale(VAS) score and Oswestry dysfunction index(ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle(LKCA), thoracic kyphosis(TK), lumbar lordosis(LL), and sagittal vertebral axis(SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up. Results No complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up(P<0.05). There was no significant difference between at 1 week after operation and at last follow-up(P>0.05). There was no significant difference in LL before and after operation(F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months a
作者 徐文强 于海洋 梁成民 翟云雷 崔西龙 王伟 张伟 XU Wenqiang;YU Haiyang;LIANG Chengmin;ZHAI Yunlei;CUI Xilong;WANG Wei;ZHANG Wei(Department of Orthopaedics,Fuyang Clinical College,Anhui Medical University,Fuyang Anhui,236000,P.R.China)
出处 《中国修复重建外科杂志》 CAS CSCD 北大核心 2019年第11期1406-1413,共8页 Chinese Journal of Reparative and Reconstructive Surgery
基金 安徽省科技厅2017年重点研究与开发计划项目(1704a0802159)。
关键词 脊柱骨折 椎间隙松解 骨质疏松 打压植骨 后凸畸形 Spine fracture intervertebral release osteoporosis bone impaction grafting kyphosis
作者简介 通信作者:于海洋,Email:fy.yhy@163.com。
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