侧前方入路椎体次全切除固定融合术治疗陈旧性骨质疏松椎体压缩性骨折继发胸腰椎后凸畸形  

Lateral Anterior Decompression and Correction for Thoracolumbar Kyphosis Secondary to Old Osteoporotic Vertebral Compression Fractures

作　　者：姜宇[1] 郭昭庆[1] 李危石[1] 陈仲强[1] 齐强[1] 曾岩[1] 孙垂国[1] 钟沃权[1] 孙卓然[1] Jiang Yu;Guo Zhaoqing;Li Weishi(Department of Orthopedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China)

机构地区：[1]北京大学第三医院骨科脊柱疾病研究北京市重点实验室,北京100191

出　　处：《中国微创外科杂志》2021年第3期220-225,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨侧前方入路椎体次全切除固定融合术治疗陈旧性骨质疏松椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)继发胸腰椎后凸畸形的临床疗效。方法2004年5月~2016年6月采用侧前方入路椎体次全切除固定融合术治疗陈旧性OVCF继发胸腰椎后凸畸形22例。通过侧前方入路显露至骨折椎体,进行骨折椎体次全切除术,植入装有自体骨的钛网或人工椎体,选用侧方钉棒或钉板装置固定至相邻椎体,透视证实内固定位置满意后完成手术。影像学评估包括后凸角(Cobb角)、腰椎前凸角(lumbar lordosis,LL),采用日本骨科学会(Japanese Orthopedic Association,JOA)29分法(JOA-29)、视觉模拟评分(Visual Analogue Score,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估患者生活质量,改良Frankel分级系统评估患者手术前后神经功能状态。结果手术时间(199.1±50.4)min,术中出血量(793.2±479.4)ml,术后住院时间(5.4±1.0)d。1例术中发现胸膜撕裂,即刻修补,术后恢复满意,无胸腔积液;1例围术期出现少量胸腔积液,未达到放置胸腔闭式引流标准,保守治疗满意后出院。术后即刻Cobb角19.5°±2.3°,与术前Cobb角29.4°±3.2°差异有显著性(P=0.000),末次随访Cobb角25.8°±2.5°,与术前Cobb角差异无显著性(P=0.056)。术前11例出现神经损害,改良Frankel分级分别为5例D1级,5例D2级,1例D3级,术后9例恢复至少1级(Z=-3.035,P=0.002)。22例术后平均随访96.3月(39~133个月),末次随访均未出现症状复发和经历翻修手术,腰背部疼痛VAS评分、JOA-29评分和ODI均较术前明显改善(均P=0.000)。结论对于单节段陈旧性OVCF继发胸腰椎后凸畸形,侧前方入路椎体次全切除固定融合手术是一种可选择的手术方式,总体疗效满意,一定程度矫正局部后凸畸形,有效解除前方神经压迫,重建脊柱前柱的稳定性。Objective To investigate the clinical efficacy of lateral anterior decompression and correction for thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fractures(OVCF).Methods A retrospective analysis was conducted on 22 patients with thoracolumbar kyphosis secondary to OVCF treated by lateral anterior approach in our hospital from May 2004 to June 2016.The fractured vertebra was exposed through the lateral anterior approach.The vertebral corpectomy was performed and a titanium mesh with autologous bone or artificial vertebral body was implanted.And then,a lateral rod or plate was fixed in the adjacent vertebrae.Radiographic evaluations were assessed including local kyphotic angle(Cobb’s angle),lumbar lordosis before and after surgery.The JOA-29 score,Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)were assessed to evaluate the clinical outcomes.The modified Frankel grading system was assessed to evaluate the neurological function.The operation time,intraoperative blood loss,and perioperative complications were observed.Results The operation time was(199.1±50.4)min,the intraoperative blood loss was(793.2±479.4)ml,and the postoperative hospital stay was(5.4±1.0)d.One case of pleural tear was found during the operation,which was repaired immediately,and the postoperative recovery was satisfactory without pleural effusion.One case had a small amount of pleural effusion during the perioperative period,which did not meet the standard of closed thoracic drainage,and was discharged after satisfactory conservative treatment.The immediate postoperative kyphotic Cobb’s angle of 22 cases was 19.5°±2.3°,having significantly difference with preoperative local kyphotic Cobb’s angle(29.4°±3.2°,P=0.000).The final follow-up kyphotic Cobb’s angle was 25.8°±2.5°,which had no significant difference compared with preoperation(P=0.056).Neurological impairment was observed in 11 patients before the operation.The modified Frankel classification was 5 cases in D1,5 cases in D2,and 1

关 键 词：骨质疏松症 椎体压缩性骨折 胸腰椎后凸畸形 侧前方入路手术 

分 类 号：R68[医药卫生—骨科学]