钉棒固定融合术在椎体成形术后翻修中的疗效  

Efficacy of screw-rod fixation and fusion in revision surgery after vertebroplasty

作　　者：胡旭栋[1] 马维虎[1] 蒋伟宇[1] 陈云琳[1] 王扬[1] Hu Xudong;Ma Weihu;Jiang Weiyu;Chen Yunlin;Wang Yang(Department of Spine Surgery,Zhejiang Ningbo No.6 Hospital,Ningbo 315040,China)

机构地区：[1]浙江省宁波市第六医院脊柱外科,315040

出　　处：《中华创伤杂志》2020年第10期892-898,共7页Chinese Journal of Trauma

摘　　要：目的探讨钉棒固定融合术在经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体骨折(OVFs)后翻修的疗效。方法采用回顾性病例系列研究分析2014年1月—2017年12月宁波市第六医院收治的19例OVFs行PVP/PKP术后翻修患者临床资料,其中男5例,女14例;年龄58~81岁[(70.7±6.0)岁]。损伤节段:T91例,T113例,T125例,L15例,L22例,L32例,L41例。翻修手术原因及手术方式:5例感染行感染病灶清除钉棒固定融合术,9例进行性后凸畸形行截骨矫形钉棒固定融合术,5例神经功能障碍行椎管减压钉棒固定融合术。记录翻修手术时间、术中出血量、围术期并发症。感染患者术前、出院前及术后3个月通过白细胞计数(WBC)、红细胞沉降率(ESR)和C-反应蛋白(CRP)评估感染控制情况。术前、术后及末次随访时通过Cobb角变化评估后凸畸形矫正情况。末次随访时评价美国脊髓损伤协会(ASIA)分级、植骨融合情况、视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。结果患者均获随访24~46个月[(32.7±8.3)个月]。翻修手术时间为135~320 min[(226.3±75.6)min];术中出血量为350~1500 ml[(825.5±230.6)ml]。1例切口愈合不良,2例肺部感染,2例螺钉松动。患者出院前及术后3个月WBC[(7.3±0.9)×10^9/L、(6.6±0.7)×10^9/L]、ESR[(42.5±13.7)mm/h、(26.8±9.5)mm/h]、CRP[(37.3±16.3)mg/L、(17.8±8.6)mg/L]均较术前[(9.2±1.7)×10^9/L、(88.7±19.2)mm/h、(58.7±22.9)mg/L]下降(P<0.01)。后凸畸形患者术后、末次随访时Cobb角[(4.8±1.2)°、(7.3±1.6)°]较术前[(29.3±5.2)°]均明显改善(P<0.05)。2例术前ASIA分级C级和1例ASIA分级D级患者至末次随访均恢复至E级,2例术前ASIA分级C级患者至末次随访恢复至D级。19例患者末次随访时影像学提示植骨融合良好。末次随访时,腰背部VAS由术前(7.5±0.8)分降至(2.1±0.5)分(P<0.05),ODI由术前(60.7±15.2)%降至(19.9±5.9)%(P<0.05)。结论对于OVFs行PVP/PKP术后翻�Objective To investigate the efficacy of screw-rod fixation and fusion in revision surgery after percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)for osteoporotic vertebral fractures(OVFs).Methods A retrospective case series study was carried out on clinical data of 19 patients treated by revision surgery after PVP or PKP at Zhejiang Ningbo No.6 Hospital from January 2014 to December 2017.There were 5 males and 14 females,with age of(70.7±6.0)years(range,58-81 years).Injured segment was located at T9 in 1 patient,T11 in 3,T12 in 5,L1 fracture in 5,L2 in 2,L3 in 2 and L4 in 1.Caused for revision and operation methods were as follows,5 patients underwent debridement,screwrod fixation and fusion due to infection,9 patients underwent osteotomy due to progressive kyphosis,screwrod fixation and fusion,5 patients underwent spinal canal decompression,screwrod fixation and fusion due to neurological dysfunction.The operation time,intraoperative blood loss,and perioperative complications were recorded.The white blood cell(WBC),erythrocyte sedimentation rate(ESR)and Creactive protein(CRP)were used to evaluate the control of infection before operation,before discharge and at postoperative 3 months.The changes in Cobb angle were measured before and after operation and at the final follow-up.The American spinal injury association(ASIA)scale,visual analog scale(VAS)and Oswestry disability index(ODI)were evaluated at the final follow-up.Results All patients were followed up for 24-46 months[(32.7±8.3)months].The revision operation time was 135-320 minutes[(226.3±75.6)minutes].The intraoperative blood loss was 350-1500 ml[(825.5±230.6)ml].There were 1 patient with poor wound healing,2 with pulmonary infection,and 2 with hardware loosening.The WBC,ESR and CRP decreased from preoperative(9.2±1.7)×10^9/L,(88.7±19.2)mm/h,(58.7±22.9)mg/L to(7.3±0.9)×10^9/L,(42.5±13.7)mm/h,(37.3±16.3)mg/L before discharge,and(6.6±0.7)×10^9/L,(26.8±9.5)mm/h,(17.8±8.6)mg/L at postoperative 3 months(P<0.01).Th

关 键 词：椎体成形术 骨质疏松性骨折 再手术 并发症 

分 类 号：R687.3[医药卫生—骨科学]