俯卧位脊柱全长加压CT检查在陈旧性骨质疏松性脊柱骨折伴中重度后凸畸形中的作用  

Effect of full-spine compression CT in prone position on the orthosis of old osteoporotic spine fracture with moderate and severe kyphosis

作　　者：张坤坤 于海洋[1] 梁成民[1] 翟云雷[1] 崔西龙[1] 王伟[1] 张伟[1] 张旭 徐文强 ZHANG kun-kun;YU Hai-yang;LIANG Cheng-min;ZHAI Yun-lei;CUI Xi-long;WANG Wei;ZHANG Wei;ZHANG Xu;XU Wen-qiang(Fuyang people's Hospital,Fuyang Clinical College,Anhui Medical University,Fuyang,Anhui 236000,China)

机构地区：[1]安徽医科大学阜阳临床学院阜阳市人民医院,安徽阜阳236000

出　　处：《颈腰痛杂志》2021年第3期313-317,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的探讨俯卧位脊柱全长加压CT检查在陈旧性骨质疏松性脊柱骨折伴中重度后凸畸形中的意义。方法回顾性分析2016年12月-2019年6月在本院行后路脊柱畸形矫正术的陈旧性骨质疏松性脊柱骨折伴中重度后凸畸形患者34例,其中男5例,女29例;年龄55~75岁,平均64.8岁。病程8~30个月,平均18.5个月。根据是否截骨,分为非截骨组9例,截骨组25例。统计分析所有患者年龄、性别、术中出血量、手术时间、固定节段、截骨级别等资料,并采用俯卧位脊柱全长加压CT片测量局部后凸Cobb角(local kyphosis cobb Angle,LKCA)、脊柱后凸柔韧性(kyphosis flexibility,KF),采用站立位脊柱全长侧位X线片测量局部后凸Cobb角、术后2周及末次随访时的站立位局部后凸Cobb角,术前、术后3个月及末次随访时评测其疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI);采用相关性分析探讨脊柱后凸柔韧性与矫形率(correction rate,CR)的相关性。结果两组年龄、性别构成、术前站立位LKCA无明显差异(P>0.05),两组术前俯卧位LKCA、KF差异有统计学意义(P<0.05)。截骨组术中出血量、手术时间、固定节段数高于非截骨组(P<0.05);两组术后2周站立位LKCA较术前明显改善(P<0.05),末次随访无明显矫形丢失;末次随访VAS评分和ODI指数较术前明显著改善。非截骨组的KF、CR分别为(0.47±0.05)、(0.65±0.09),KF与CR明显相关(r=-0.685,P<0.05);截骨组KF、CR分别为(0.34±0.10)、(0.61±0.13),两者无相关性(r=0.330,P>0.05)。结论术前俯卧位脊柱全长加压CT检查可指导陈旧性骨质疏松性脊柱骨折伴中重度后凸矫形手术方案的选择,对于非截骨组可根据脊柱柔韧性预测术后矫形效果。Objective Investigate the significance of full-spine compression CT in prone position in the orthopaedic treatment of old osteoporotic spinal fractures with moderate and severe kyphosis.Methods A retrospective analysis of 34 cases of old osteoporotic spine fractures with moderate to severe kyphotic deformity who underwent posterior spinal deformity correction surgery in our hospital from December 2016 to June 2019,including 5 males and 29 females;The age is 55-75 years old,with an average of 64.8 years old.The course of illness was from 8 to 30 months,with an average of 18.5 months.According to the osteotomy,they were divided into non-osteotomy grouP(9 cases)and osteotomy grouP(25 cases).The age,gender,and full-length compression CT of prone spine of the two groups were statistically analyzed to measure local kyphosis cobb Angle(LKCA),kyphosis flexibility(KF),full-length lateral X-ray of the standing spine,local kyphotic Cobb angle,2 weeks postoperative and last follow-up,standing local kyphosis Cobb angle,preoperative,Three months after surgery and the final follow-up,the visual analogue scale(VAS)and Oswestry disability index(ODI),intraoperative blood loss,operation time,fixed segment,and osteotomy level were used;correlation Analyze and explore the correlation between kyphosis flexibility and correction rate(CR).Results There was no significant difference between the two groups in age,gender composition,and preoperative standing LKCA(P>0.05).The preoperative LKCA and KF differences in the prone position were statistically significant(P<0.05).Intraoperative blood loss,operation time,and number of fixed segments in the osteotomy grouPwere higher than those in the non-osteotomy grouP(P<0.05);the standing LKCA in the two groups was significantly improved 2 weeks after the operation compared with before the operation(P<0.05),and there was no significant difference in the last follow-uPOrthosis was lost;the VAS score and ODI score at the last follow-uPwere significantly improved compared to before surgery.In the non

关 键 词：俯卧位脊柱全长加压CT检查 脊柱后凸柔韧性 矫形率 局部后凸Cobb角 

分 类 号：R682.13[医药卫生—骨科学]