摘要
目的探讨侧卧位单侧椎弓根外入路无痛椎体强化术治疗合并内科重症骨质疏松性椎体压缩骨折(OVCFs)患者的临床疗效.方法采用回顾性病例系列研究分析2004年4月—2017年1月河南省人民医院收治的97例合并内科重症OVCFs患者临床资料,其中男27例,女70例;年龄59~99岁[(78.5±13.2)岁].3节段骨折11例,2节段骨折9例,单椎体骨折77例.均采用侧卧位单侧入路无痛椎体强化术,术后康复医师指导训练.记录手术时间和术中出血量.评估患者术前术中呼吸频率、心率、收缩压、血氧饱和度、急性生理学和慢性健康状态评估Ⅱ(APACHEⅡ)评分、椎体压缩部位高度、伤椎Cobb角.采用视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评估患者功能改善情况.同时观察再骨折及并发症发生情况.结果患者均获随访3~8个月[(6.3±2.9)个月].手术时间为(69.2±25.9)min;术中出血量为(7.5±2.6)ml.术中患者呼吸频率、心率、收缩压及血氧饱和度与术前比较差异均无统计学意义(P>0.05),无手术中止或恶化效应发生.APACHEⅡ评分术前为(15.2±3.7)分,术后24h为(8.4±0.7)分(P<0.05).伤椎压缩部位高度术前为(17.2±3.6)mm,术后1周为(20.4±1.3)mm,末次随访时为(18.8±1.3)mm,与术前比较差异无统计学意义(P>0.05).伤椎Cobb角术前为(25.6±9.3)°,术后1周为(20.7±2.5)°,末次随访为(18.5±3.1)°,与术前比较差异无统计学意义(P>0.05).VAS术前为(8.5±1.2)分,术后1周为(2.1±0.3)分,末次随访为(3.2±1.1)分,与术前比较改善明显(P<0.05),但末次随访与术后1周比较差异无统计学意义(P>0.05).ODI术前为39.9±3.4,术后1周为20.2±5.2,末次随访为17.2±2.0,与术前比较改善明显(P<0.05),但末次随访与术后1周比较差异仍有统计学意义(P<0.05).随访期间未出现再骨折.术中及术后随访期间未发生神经损伤、肺栓塞、死亡等严重并发症.结论采用侧卧位单侧入路无痛椎体强化术治疗合并内科重症患者OVCFs,术中能提高患者的手术耐受性和满意度,缩短手术时间,缓解术后疼痛及促进功能康复,是一种可供选择的手术方式.
Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures(OVCFs)in the critically ill patients under lateral decubitus postition.Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017.There were 27 males and 70 females,aged 59-99 years[(78.5±13.2)years].There were 11 patients with three-segment fracture,nine patients with two-segment fracture and 77 patients with single fracture.All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians.Preoperative and intraoperative blood loss were recorded.Preoperative and postoperative respiratory rate,heart rate,systolic pressure,oxygen saturation and acute physiology and chronic health evaluation score II(APACHE II),height of vertebral compression site,and injured vertebrae Cobb angle were evaluated.The visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were assessed to define function improvement.Meanwhile,the occurrence of re-fracture and complications were recorded.Results All patients were followed up for 3-8 months[(6.3±2.9)months].The operation time was(69.2±25.9)minutes,and the amount of intraoperative bleeding was(7.5±2.6)ml.There were no significant differences in respiratory rate,heart rate,systolic blood pressure or oxygen saturation before operation and after operation(P>0.05).No surgical discontinuation or deterioration occurred.The APACHE II score was(15.2±3.7)points before operation and(8.4±0.7)points at 24 hours after operation(P<0.05).The compression height parameter of the injured vertebraewas(17.2±3.6)mmbeforesurgery,(20.4±41.3)mmatoneweekaftersurgery,and(18.8±1.3)mm at the last follow-up(P>0.05).The Cobb angle was(25.6±9.3)°before operation,(20.7±2.5)°at one week after operation and(18.5±3.1)°at the last follow-up(P>0.05).The VAS score was(8.5±1.2)points before operation,(2.1±0.3)points at one week after operation,and(3.2±1.1)points at the last follow-up,respectively.The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS(P<0.05),but there was no significant difference between the former two(P>0.05).The ODI value was 39.9±3.4 before operation,20.2±5.2 at one week after operation,and 17.2±2.0 at the last follow-up.The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI(P<0.05),showing improvement trend during the follow-up(P<0.05).No re-fracture occurred during the follow-up.No serious complications such as nerve injury,pulmonary embolism or death occurred during the operation and postoperative follow-up.Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction,shorten the operation time,relieve postoperative pain and promote functional recovery.It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine.
作者
赵亮
张锴
曹臣
高延征
邢帅
田冬冬
陈书连
Zhao Liang;Zhang Kai;Cao Chen;Gao Yanzheng;Xing Shuai;Tian Dongdong;Chen Shulian(Department of Orthopedics,Zhengzhou First People's Hospital,Zhengzhou 450000,China;Department of Spine and Spine Cord Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2019年第8期693-699,共7页
Chinese Journal of Trauma
基金
河南省医学科技重点攻关项目(201502024)
河南省科技厅基础与前沿项目(1221102310145).
关键词
脊柱骨折
骨质疏松性骨折
椎体强化术
Spinal fractures
Osteoporotic fractures
Vertebral augmentation
