摘要
目的探讨经椎弓根下椎体椎间隙截骨术治疗陈旧性骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)继发胸腰段后凸畸形的临床疗效。方法回顾分析2016年1月—2020年12月采用经椎弓根下椎体椎间隙截骨术治疗的11例陈旧性OVCF继发胸腰段后凸畸形患者的临床资料。其中男2例,女9例;年龄50~77岁,平均61.3岁。病程6个月~50年,中位时间8年。骨折原因:9例有明确外伤史,2例无明显诱因。骨折节段:T12 3例,L1 7例,L2 1例。记录患者手术时间、术中出血量、术后引流量及并发症情况;术前、术后7 d及末次随访时行脊柱全长及术区局部X线片检查,测量胸腰段后凸Cobb角并计算矫正率;术前、术后1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)评价患者疼痛和功能改善情况。结果所有手术均顺利完成,手术时间140~215 min,平均188.6 min;术中出血量100~500 mL,平均268.2 mL;术后引流量160~1 500 mL,平均615.5 mL。1例患者术后出现双侧大腿反跳性疼痛,予以营养神经和止痛对症处理后缓解。11例患者均获随访,随访时间6~56个月,平均14.7个月。末次随访时影像学检查示均达骨性融合,无内固定物断裂、松动或移位等情况发生。术后7 d和末次随访时后凸Cobb角均较术前明显改善(P<0.05),术后7 d和末次随访间差异无统计学意义(P>0.05);术后7 d和末次随访时后凸Cobb角矫正率分别为68.0%±9.8%和60.3%±11.9%。术后1个月和末次随访时VAS评分、ODI均较术前显著改善,末次随访时较术后1个月进一步改善,差异均有统计学意义(P<0.05)。结论经椎弓根下椎体椎间隙截骨术创伤小、手术时间短、术中出血量少,是治疗陈旧性OVCF继发胸腰段后凸畸形的有效方式,可获得良好的矫形效果和生活质量。
Objective To investigate the effectiveness of transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture(OVCF). Methods The clinical data of 11 patients with thoracolumbar kyphosis caused by old OVCF treated by transvertebral space and under the pedicle osteotomy between January 2016 and December 2020 were retrospectively analyzed. There were 2 males and9 females, with an average age of 61.3 years(range, 50-77 years) and with a median disease duration of 8 years(range,6 months to 50 years). Fracture reasons: 9 cases had a clear history of trauma, and 2 cases had no obvious incentive. A total of 11 vertebrae was involved in fracture, including T12 in 3, L1 in 7, L2 in 1. The operation time, intraoperative blood loss,postoperative drainage volume, and complications were recorded. Full-length X-ray films of spine and local X-ray films of the operation area were examined before operation, at 7 days after operation, and at last follow-up. The Cobb angle of thoracolumbar kyphosis was measured, and the correction rate was calculated. The visual analogue scale(VAS) score and Oswestry disability index(ODI) were recorded to assess patients’ pain and functional improvement before operation, at 1 month after operation, and at last follow-up. Results All operations were successfully completed. The average operation time was 188.6 minutes(range, 140-215 minutes);the average intraoperative blood loss was 268.2 mL(range, 100-500 mL);the average postoperative drainage volume was 615.5 mL(range, 160-1 500 mL). One patient developed bilateral thigh rebound pain after operation, which relieved after symptomatic treatment of nutritional nerve and acesodyne. All patients were followed up 14.7 months on average(range, 6-56 months). At last follow-up, osseous fusion was observed in all patients, and no fracture, loose, or displacement of internal fixator was observed on imaging. At7 days after operation and at last follow-up, the Cobb angle of thoracolumbar kyphosis significantly improved when compared with preoperative one(P<0.05), and there was no significant difference between at 7 days after operation and at last follow-up(P>0.05);the correction rates of Cobb angle at 7 days after operation and at last follow-up were 68.0%±9.8%and 60.3%±11.9%, respectively. At 1 month after operation and at last follow-up, the VAS score and ODI significantly improved when compared with preoperative ones, and further improved at last follow-up when compared with those at1 month after operation, all showing significant differences(P<0.05). Conclusion Transvertebral space and under the pedicle osteotomy is an effective way to treat thoracolumbar kyphosis caused by old OVCF with less trauma, shorter operation time, and less intraoperative blood loss. Patients can obtain good orthopedic results and quality of life.
作者
秦杰
苏保
王霖邦
唐可
刘瑞雪
权正学
QIN Jie;SU Bao;WANG Linbang;TANG Ke;LIU Ruixue;QUAN Zhengxue(Department of Orthopedics,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,P.R.China;Graduate School of Chongqing Medical University,Chongqing,400016,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第3期305-309,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(82072976)
重庆市科卫联合医学科研资助项目(2021MSXM143)。
关键词
骨质疏松性椎体压缩骨折
脊柱后凸畸形
经椎弓根下椎体椎间隙截骨术
Osteoporotic vertebral compression fracture
kyphosis deformity
transvertebral space and under the pedicle osteotomy
