经椎弓根部位椎体楔形截骨治疗骨质疏松性脊柱陈旧性骨折伴后凸畸形  

Posterior spinal transpedicular wedge osteotomy for kyphosis due to delayed osteoporotic vertebral fracture in elderly

作　　者：杨保辉[1] 李浩鹏[1] 贺西京[1] 张纯[1] 秦杰[1] 

机构地区：[1]西安交通大学第二附属医院骨二科,陕西西安710004

出　　处：《中国骨伤》2015年第8期749-753,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：探讨后路经椎弓根部位截骨矫形术治疗骨质疏松性脊柱陈旧性骨折伴后凸畸形临床效果。方法 ：2009年7月至2014年2月采用后路经椎弓根截骨矫形治疗26例骨质疏松性陈旧性脊柱骨折伴后凸畸形的患者,其中男10例,女16例,年龄55~75岁,平均67岁;胸椎1例,胸腰椎21例,腰椎4例;共29个椎体骨折,单椎体骨折23例,双椎体骨折3例;术前后凸Cobb角为32°~51°,平均（42.00±4.75）°;VAS评分6~9分,平均（8.40±0.75）分,脊髓功能按Frankel分级：D级4例,E级22例。记录术中出血量、手术时间及围手术期并发症,采用X线片观察Cobb角改善情况,应用VAS评分评价疼痛缓解情况,应用Frankel分级评价神经功能恢复情况。结果：26例患者手术时间120~175 min,平均155 min;术中出血量800~1 500 ml,平均1 100 ml。术后第2天时Cobb角5°~15°,平均（9.60±2.50）°,较术前明显改善（P〈0.05）,改善率76%;VAS评分1~5分,平均4.00±1.00,较术前明显改善（P〈0.05）;脊髓功能Frankel分级1例由E级变为C级,其余未有加重情况。术后随访3~24个月,平均16.4个月。末次随访时Cobb角5°~19°,平均（11.00±3.50）°,VAS评分1~6分,平均（4.40±1.25）分,术后脊髓功能Frankel分级由E级变为C级1例,恢复至D级,余无加重病例。1例患者术后3个月出现固定节段下位椎体骨折,1例患者术后5个月出现固定节段上位相邻节段椎体骨折,均予对症、抗骨质疏松治疗后胸背痛症状缓解;影像学可见植骨融合,未见内固定松动及断裂。结论：经椎弓根截骨矫形术治疗骨质疏松性脊柱陈旧性骨折伴后凸畸形,可以取得良好的临床效果,但需重视术中操作及术后相邻节段椎体骨折的预防。Objective：To evaluate the clinical effects of posterior spinal transpedicular wedge osteotomy for kyphosis due to delayed osteoporotic vertebral fracture in elderly. Methods：From July 2009 to February 2014,26 patients with kyphosis caused by delayed osteoporotic vertebral fracture were treated with transpedicular wedge osteotomy. There were 10 males and16 females,aged from 55 to 75 years old with an average of 67 years. There were 1 osteotomy in thoracic vertebra,21 osteotomies in thoracolumbar vertebrae and 4 in lumbar vertebrae. Total 29 vertebrae were involved,23 cases with single vertebral fracture and 3 cases with double vertebral fractures. Preoperative Cobb angles were 32°~51° with the mean of（42.00 ±4.75） ° and VAS scores were 6 to 9 points with an average of（8.40±0.75） points. According to the Frankel grade of spinal cord function,4 cases were grade D and 22 cases were grade E. Intraoperative bleeding,operation time and perioperative complications were recorded,and improvements of Cobb angle were evaluated by X rays. VAS score and Frankel grade were respectively used to evaluate the pain and nerve function. Results：The average operation time were 155 min（ranged,120 to 175） and the mean intraoperative bleeding were 1 100 ml（ranged,800 to 1 500）. Postoperative at 2 days,Cobb angle and VAS score were（9.60±2.50） ° and（4.00±1.00） points,respectively,ranged from 5° to 15° and 1 to 5 points. VAS score and Cobb angle improved obviously compared with preoperative（P〈0.05）,and the improvement rate of Cobb angle was 76%. Frankel grade of1 case changed from grade E to C,and the others did not become worse. The follow up period ranged from 3 to 24 months with an average of 16.4 months. At the final follow up,Cobb angles and VAS score were（11.00±3.50） °and（4.40±1.25） points,respectively,ranged from 5° to 19° and 1 to 6 points. The patient whose Frankel grade E changed to C at 2 days after surgery and changed to grade D at the latest follow up. Vertebral body fr

关 键 词：脊柱后凸 脊柱骨折 骨质疏松 截骨术 

分 类 号：R683.2[医药卫生—骨科学]