摘要
目的探讨骨水泥螺钉联合多节段SchwabⅠ级截骨治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形的临床疗效。方法回顾分析2015年6月—2017年6月收治且符合选择标准的27例陈旧性胸腰椎骨质疏松性骨折伴后凸畸形患者。男8例,女19例;年龄56~81岁,平均69.5岁。损伤节段(后凸顶点):T114例、T1212例、L110例、L21例。病程3~21个月,平均12.5个月。腰椎骨密度T值-4.9^-2.5,平均-3.61。采用美国脊髓损伤协会(ASIA)分级评价脊髓损伤情况,D级1例,E级26例。分别于术前、术后2周、术后3个月及末次随访时获得患者胸腰部疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、骨折部位后凸Cobb角及脊柱矢状面轴向距离(sagittal vertical axis,SVA)数据,评估患者生活质量和脊柱矢状面参数改善情况。结果患者术中未出现椎弓根螺钉植钉和骨水泥相关并发症。术后26例切口Ⅰ期愈合;1例因血糖控制不佳切口愈合不良,经换药后愈合。术后未出现褥疮、坠积性肺炎及下肢深静脉血栓形成等并发症。27例患者均获随访,随访时间8~24个月,平均16.6个月。术后各时间点VAS评分、ODI评分、Cobb角及SVA均较术前显著改善(P<0.05)。术后各时间点间Cobb角比较差异均无统计学意义(P>0.05);术后3个月及末次随访时VAS评分和ODI评分显著优于术后2周(P<0.05),与术后3个月时比较,末次随访时ODI评分进一步改善(P<0.05),而VAS评分差异无统计学意义(P>0.05);末次随访时SVA与术后2周及3个月比较差异有统计学意义(P<0.05),术后2周及3个月间差异无统计学意义(P>0.05)。随访期间均未发现椎弓根螺钉松动、断裂或切割,邻近节段椎体骨折,近端交界性后凸畸形等并发症。结论采用骨水泥螺钉联合多节段SchwabⅠ级截骨治疗陈旧性胸腰椎骨质疏松性骨折伴后凸畸形手术创伤小、术后恢复快,临床疗效显著。
Objective To evaluate the effectiveness of cement-injectable cannulated pedicle screw combined with multiple level Schwab gradeⅠosteotomy for chronic thoracolumbar osteoporotic fractures with kyphosis.Methods The clinical data of 27 patients with symptomatic chronic thoracolumbar osteoporotic fractures combined with kyphosis treated between June 2015 and June 2017 were retrospectively analysed.Among them,there were 8 males and 19 females,with an average age of 69.5 years(range,56-81 years).The damage segment(kyphosis vertex)included T11 in 4 cases,T12 in 12 cases,L1 in 10 cases,and L2 in 1 case.The disease duration ranged from 3 to 21 months,with an average of 12.5 months.The T value of lumbar vertebral bone mineral density ranged from-4.9 to-2.5,with an average value of-3.61.The American Spinal Injury Association(ASIA)classification was used to evaluate spinal cord injury,there were 1 case of grade D and 26 cases of grade E.The visual analogue scale(VAS)score,Oswestry disability index(ODI),kyphosis Cobb angle of fracture site,and sagittal vertical axis(SVA)data were obtained before operation,at 2 weeks after operation,3 months after operation,and last follow-up,to evaluate the quality of life and improvement of sagittal spine parameters.Results No complications related to pedicle screw and bone cement occurred.The incisions healed by first intention in 26 cases,and 1 incision healed after dressing change due to poor blood glucose control.There were no complications such as bedsore,hypostatic pneumonia,or deep venous thrombosis.All patients were followed up 8-24 months,with an average of 16.6 months.The VAS score,ODI score,Cobb angle,and SVA were significantly improved when compared with those before operation(P<0.05).There was no significant difference in Cobb angle between each time point after operation(P>0.05);the VAS score and ODI score at 3 months after operation and last follow-up were significantly better than those at 2 weeks after operation(P<0.05),and the ODI score at last follow-up was further improved when compared with the score at 3 months(P<0.05),but there was no significant difference in VAS score(P>0.05);SVA at last follow-up was significantly worse than that at 2 weeks and 3 months after operation(P<0.05),but there was no significant difference between at 2 weeks and 3 months after operation(P>0.05).During the follow-up period,there was no complication such as pedicle screw loosening,breakage or cutting,adjacent vertebral fracture,proximal junctional kyphosis,and so on.Conclusion For the chronic thoracolumbar osteoporotic fractures combined with kyphosis,the cement-injectable cannulated pedicle screw and multiple level Schwab gradeⅠosteotomy has the advantages of less operation trauma,quick recovery,and remarkable effectiveness.
作者
张迪
张文明
周献伟
沈慧勇
靳松
ZHANG Di;ZHANG Wenming;ZHOU Xianwei;SHEN Huiyong;JIN Song(Department of Spinal Surgery,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Zhengzhou Henan,450000,P.R.China;Department of Orthopedics,the Eighth Affiliated Hospital of Sun Yat-sen University,Shenzhen Guangdong,518033,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第12期1533-1538,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
骨水泥螺钉
SchwabⅠ级截骨
骨质疏松症
胸腰椎骨折
后凸畸形
Cement-injectable cannulated pedical screw
Schwab gradeⅠosteotomy
osteoporosis
thoracolumbar fracture
kyphosis
