摘要
目的探讨陈旧性胸腰椎骨质疏松性椎体压缩骨折(OVCFs)按不同损伤分级手术治疗的效果.方法采用回顾性病例系列研究分析2013年2月—2016年11月西安交通大学医学院附属红会医院收治的238例陈旧性胸腰椎OVCFs患者临床资料,其中男49例,女189例;年龄63~78岁,平均66.8岁.骨密度T值为(-3.8±0.3)SD.损伤节段:T7~T935例,T10~L2171例,L3~L432例.16例伴神经损伤,神经功能美国脊髓损伤协会(ASIA)分级C级14例,D级2例.依据患者临床表现及影像学表现复杂程度分为Ⅰ~Ⅴ级并进行个性比处理:Ⅰ级86例,采用椎体强化术;Ⅱ级60例,采用后路复位融合内固定术,必要时联合椎体强化术;Ⅲ级44例,采用后路减压复位融合内固定术;Ⅳ级30例,采用后路截骨矫形融合内固定术;Ⅴ级18例,采用后路截骨(减压)矫形融合内固定术.记录术前及末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎体矢状面指数、ASIA分级,同时观察并发症发生情况.结果患者均获随访12~38个月,平均18.5个月.Ⅰ~Ⅴ级患者VAS由术前(8.0±0.7)分、(8.1±0.7)分、(8.3±0.89)分、(8.1±0.7)分、(8.2±0.2)分改善至末次随访时的(2.1±0.8)分、(2.0±0.8)分、(2.2±0.8)分、(2.3±0.8)分、(2.2±0.8)分(P均<0.05);ODI由术前69.5±3.0、70.1±2.0、70.3±2.1、69.9±1.9、70.0±2.2改善至末次随访的39.8±2.2、39.1±2.4、40.1±2.1、39.0±2.3、39.5±2.3(P均<0.05).椎体矢状面指数由(89.7±2.1)%、(74.4±8.3)%、(75.0±6.7)%、(72.3±5.2)%、(71.1±2.1)%改善为(85.2±7.4)%、(84.2±5.5)%、(85.1±4.4)%、(86.2±3.5)%、(83.4±1.7)%(P均<0.05).16例伴神经损伤的患者,ASIA分级由术前C级14例、D级2例改善至末次随访的D级4例、E级12例.共11例(Ⅰ级7例、Ⅱ级1例、Ⅳ级2例、Ⅴ级1例)患者后期出现了椎体高度丢失,但仅有2例因出现严重的腰背痛,而行二次手术治疗.结论对于陈旧性胸腰椎OVCFs,应用按不同损伤分级手术的理念能有效指导该类患者的治疗策略,针对不同复杂程度不同病情的患者行不同的手术方案,能有效减轻疼痛、恢复脊柱稳定性、矫正后凸畸形、解除神经压迫、促进功能恢复.
Objective To investigate the effect of graded surgical treatment according to injury classification on old thoracolumbar vertebral compression fractures ( OVCFs). Methods A retrospective case series study was conducted to analyze the clinical data of 238 patients with old thoracolumbar OVCFs admitted to the Honghui Hospital affiliated to the College of Medicine, Xi'an Jiaotong University from February 2013 to November 2016. There were 49 males and 189 females, aged 63-78 years, with an average age of 66. 8 years. The bone density T value was (-3. 8 ± 0. 3)SD. The injured segments were located at T7-T9 in 35 patients, T10-L2 in 171, and L3-L4 in 32. A total of 16 patients had neurological injury, including 14 with grade C and two with grade D according to the American Spinal Injury Association ( ASIA) neurological function classification. According to the patient's clinical manifestations and imaging complexity, the patients were assigned with I to V grades for individualized surgical treatment. Among them, 86 patients with grade I were treated with vertebral augmentation;60 patients with grade II received posterior reduction and internal fixation combined with vertebral augmentation when necessary;44 patients with grade III were treated with posterior decompression and reduction and internal fixation;30 patients with grade IV received posterior osteotomy and orthopedic fusion;18 patients with grade V were treated based on the major symptoms. The visual analogue score ( VAS ), Oswestry dysfunction index ( ODI), vertebral sagittal index, and the American Spinal Injury Association ( ASIA) grading before operation and at the last follow-up as well as the postoperative complications were recorded. Results All patients were followed up for 12-38 months with an average of 18. 5 months. The VAS of patients with grade I to V improved from preoperative (8. 0 ± 0. 7)points,(8. 1 ± 0. 7)points,(8. 3 ± 0.89)points,(8.1±0.7)points,(8.2±0.2)pointsto(2.1±0.8)points,(2.0±0.8)points,(2.2± 0. 8)points,(2. 3 ± 0. 8)points,(2. 2 ± 0. 8)points at the last follow-up (P<0. 05);ODI was improved from preoperative 69. 5 ± 3. 0, 70. 1 ± 2. 0, 70. 3 ± 2. 1, 69. 9 ± 1. 9, 70. 0 ± 2. 2 to 39. 8 ± 2. 2, 39. 1 ± 2. 4, 40. 1 ± 2. 1, 39. 0 ± 2. 3, 39. 5 ± 2. 3 at the last follow-up (P<0. 05);the vertebral sagittal index improved from (89. 7 ± 2. 1)%,(74. 4 ± 8. 3)%,(75. 0 ± 6. 7)%,(72. 3 ± 5. 2)%,(71. 1 ± 2. 1)%to (85.2 ±7.4)%,(84.2 ±5.5)%,(85.1 ±4.4)%,(86.2 ±3.5)%,(83.4 ±1.7)%(P<0.05). For 16 patients with nerve injury, the ASIA grading was improved from preoperative grade C in 14 patients and grade D in two patients to grade D in four patients and grade E in 12 patients at the last follow-up. A total of 11 patients ( seven patients with grade I, one with grade II, two with grade IV, and one patient with grade V) had vertebral height loss in the later stage, but only two patients underwent secondary surgery for severe low back pain. Conclusions For obsolete thoracolumbar OVCFs, the concept of graded surgery can effectively guide the treatment strategies of these patients. Different surgical schemes for patients with different conditions can effectively alleviate the pain, restore spinal stability, correct kyphosis deformity, relieve nerve compression and promote functional recovery.
作者
郭瑞
王宥涵
昌震
杨小彬
孔令擘
郝定均
贺宝荣
Guo Rui;Wang Youhan;Yang Xiao bin;Kong Lingbo;Hao Dingjun;He Baorong(School of Graduate,Shaanxi University of Chinese Medicine,Xianyang 712046,Chirui;Department of Spine Surgery,Honghui Hospital ,College of Medicine,Xi'an Jiaotong University,Xi'an 710054,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2019年第8期700-707,共8页
Chinese Journal of Trauma
基金
陕西省科技厅科技成果转移与推广计划-获奖成果转化项目(2018HJCG-08)
西安市科技局社会发展攻关项目(2017115SF/YX009).
关键词
骨质疏松性骨折
脊柱骨折
胸椎
腰椎
Osteoporotic fractures
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
