急性症状性骨质疏松性胸腰椎骨折分型及其效度检验和临床应用效果评价  

Evaluation of validity and clinical effect of acute symptomatic osteoporotic thoracolumbar fracture classification system

作　　者：郝定均[1] 张嘉男 杨俊松[1] 刘团江[1] 王晓晖 刘鹏[1] 闫亮[1] 赵元廷 赵勤鹏[1] 黄大耿 刘继军[1] 刘世长 黄云飞 拓源 田野[1] 白露露 李恒[1] 张子龙 邹鹏 王鹏涛 李庆达 柴鑫 贺宝荣[1] Hao Dingiun;Zhang Jianan;Yang Junsong;Liuu Tuanjiang;Wang Xiaohui;Lin Peng;Yan Liang;Zhao Yuanting;Zhao Qinpeng;Huang Dageng;Liu Jjun;Liu Shichang;Huang Yunfei;Tuo Yuan;Tian Ye;Bai Lulu;Li Heng;Zhang Zilong;Zou Peng;Wang Pengtao;Li Qingda;Chai Xin;HeBaorong(Department of Spine Surgery,the Affiliated Honghui Hospital of Xi an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院脊柱病医院,710054

出　　处：《美中国际创伤杂志》2021年第1期4-14,共11页U.S.Chinese International Journal of Traumatology

摘　　要：目的:建立急性症状性骨质疏松性胸腰椎骨折(ASOTLF)分型系统,并进行信度检验及其临床应用效果评价。方法:采用回顾性病例系列研究分析2016年1月至2018年12月西安交通大学医学部附属红会医院手术治疗的1293例ASOTLF患者的临床资料,其中男514例,女779例;年龄57~90岁[(71.4±6.3)岁]。骨密度T值为-5.0-2.5 SD[(-3.1±-0.4)SD]。根据临床症状和骨折的影像学表现,将ASOTLF分为4型:Ⅰ型(隐匿型)、Ⅱ型(压缩型)、Ⅲ型(爆裂型)和Ⅳ型(不稳定型),其中Ⅱ型分为ⅡA型、ⅡB型、ⅡC型3个亚型,Ⅲ型分为ⅢA型、ⅢB型2个亚型。1293例患者中,Ⅰ型75例(5.8%),ⅡA型500例(38.7%),ⅡB型134例(10.4%),ⅡC型97例(7.5%),ⅢA型442例(34.2%),ⅢB型27例(2.1%),Ⅳ型18例(1.4%)。在完成分型的效度检测后,根据分型采用不同的治疗方法。Ⅰ型采用后路经皮椎体成形术(PVP)治疗,Ⅱ型采用体位复位+PVP治疗,ⅡA型、ⅡB型分别采用经皮椎体后凸成形术(PKP)和后路切开复位减压植骨融合钉道强化内固定术治疗,Ⅳ型采用后路(减压)复位植骨融合钉道强化内固定术治疗。比较所有患者及各型患者术前、术后1个月、末次随访时视觉模拟评分(VAS).Oswestry功能障碍指数(OD)、局部Cobb角、椎体后凸角(椎体角)及Frankel脊髓损伤分级,记录神经功能恢复情况及并发症。结果:患者获随访24~43个月,平均(29.89±5.12)个月。3名观察者进行了两轮共计3000次评估。观察者间可信度总体K值平均为0.83,观察者内可信度总体K值平均为0.88。VAS,0DI总体数据均符合正态分布,所有患者术前VAS.0DI分别为(5.8±0.7)分、72.5±6.6,术后1个月分别为(1.8±0.6)分和25.0±6.3,末次随访时分别为(1.5±0.6)分和19.5±6.2(P均<0.05)。Cobb角及椎体角总体数据为非正态分布,所有患者术前Cobb角及椎体角分别为13(7,20)°和7(5,10)°,术后1个月分别为8(4,11)°和4(3,6)°,末次随访时分别为9(5,12)°和5(4,8)°(P�Objective:To establish an acute symptomatie osteoporotic thoracolumbar fraeture(ASOTLF)classification system,and to examine the reliability and evaluate its elinical application effect.Methods:A retrospective case series study was conducted to analyze the clinical data of 1293 patients with ASOTLF who underwent surgical treatment in our hospital from January 2016 to December 2018.Ineluding 514 males and 779 females.They were 57~90 years old[mean(71.4±6.3)years old]the T value of BMD was-5.0--2.5SD(-3.1±-0.4)SD).According t0 the clinical sympoms and fracture mophology.the ASOTLF is divided into 4 types,TypeⅠ(occult fracture),TypeⅡ(compressed fracture),TypeⅢ(burst fracture)and TypeⅣ(unstable fracture).TypeⅡis divided into three subtypes,including typeⅡA,typeⅡB,and typeⅡC;typeⅢis divided into two subtypes,including typeⅡA and typeⅡB.Of the 1293 patients,75(5.8%)were typeⅠ,500(38.7%)were type IⅡA,134(10.4%)were typeⅡB,97(7.5%)were typeⅡC,442(34.2%)were typeⅡA,27(2.1%)were typeⅡB and 18(1.4%)were typeⅣ.After testing the validity of the classification,different treatment methods were utilized according to the classification.Percutaneous verte-broplasty(PVP)was recommended for the typeⅠpatients.PVP after postural reduction was recommended for the typeⅡpatients.Percutaneous kyphoplasty(PKP)was recommended for the typeⅡA patients.Posterior reduction and decompression,bone graft fusion and bone cement-augmented screw fixation was recommended for the typeⅡB patients.However,posterior reduction,bone graft fusion and bone cement-augmented screw fixation was recommended for the typeⅣpatients.Visual analog score(VAS),Oswestry disability index(ODI),local Cobb angle,vertebral body angle(VBA)and Frankel grade of spinal cord injury were recorded in all types of patients before surgery,1 month after surgery and at the last follow-up.The neurological function recovery and complications were also recorded.Results:The patients were followed up for 24~43 months[mean(29.89±5.12)months].Thr

关 键 词：骨质疏松:脊柱骨折:胸椎 腰椎 骨折分型 

分 类 号：R68[医药卫生—骨科学]