老年脊柱矢状位失衡的临床特点及治疗方法  

Clinical characteristics and treatment of sagittal spinal imbalance in the elderly

作　　者：孙利玲 黄伟乐 黄尚武 王珊珊[2] SUN Li-ling;HUANG Wei-le;HUANG Shang-wu(First Invalides Hospital,Guangzhou 510260,China)

机构地区：[1]广东省第一荣军医院,510260 [2]广东轻工职业技术学院信息技术学院,510000

出　　处：《中国实用医药》2021年第24期67-69,共3页China Practical Medicine

基　　金：广东省青年创新人才项目(项目编号:2019GKQNCX054)。

摘　　要：目的研究分析老年脊柱矢状位失衡的临床特点与有效的治疗方法。方法52例老年脊柱矢状位失衡患者,均采用常规综合治疗方案,收集所有患者的相关临床资料,分析患者的病因、临床症状、合并症,比较治疗前后矢状位失衡相关指标及视觉模拟评分法(VAS)评分。结果52例患者病因包括骨质疏松25例(48.08%)、脊柱创伤10例(19.23%)、脊柱结核8例(15.38%)、肌源性脊柱后凸4例(7.69%)、脊柱炎2例(3.85%)、脊柱相关肿瘤2例(3.85%)、脊柱非特异性感染1例(1.92%)。患者临床症状包括背部疼痛52例(100.00%)、身体前倾42例(80.77%)、疲乏33例(63.46%)、行走困难18例(34.62%)。患者的合并症包括椎管狭窄12例(23.08%)、腰椎间盘突出10例(19.23%)、陈旧性椎体骨折5例(9.62%)、胸腰椎压缩性骨折5例(9.62%)。52例患者治疗后胸椎后凸角(23.59±3.82)°、腰椎前凸角(44.52±7.86)°、骨盆倾斜角(57.36±4.64)°、矢状位垂直轴(4.21±1.02)cm均显著优于治疗前的(19.84±5.86)°、(28.56±10.18)°、(65.86±6.68)°、(6.34±3.69)cm,差异具有统计学意义(P<0.05)。患者治疗前VAS评分为(6.67±2.86)分,治疗后为(3.62±1.56)分;患者治疗后VAS评分显著低于治疗前,差异具有统计学意义(t=6.7512,P=0.0000<0.05)。结论老年脊柱矢状位失衡的发病因素较多,患者临床症状主要表现为疼痛和身体前倾,易并发椎管狭窄、椎间盘突出、陈旧性椎体骨折、胸腰椎压缩性骨折。综合治疗方案治疗老年脊柱矢状位失衡通常能有效改善患者相关指标及症状,可作为脊柱矢状位失衡治疗首选方案。Objective To study and analyze the clinical characteristics and effective treatment of sagittal spinal imbalance in the elderly.Methods There were 52 elderly patients with sagittal spinal imbalance,and all received traditional conservative treatment.The relevant clinical data of the selected patients were collected,the causes,clinical symptoms,complications were analyzed,and the relevant indexes of sagittal imbalance before and after treatment,visual analogue scale(VAS)score before and after treatment were compared.Results The causes of 52 patients included osteoporosis in 25 cases(48.08%),spinal trauma in 10 cases(19.23%),spinal tuberculosis in 8 cases(15.38%),myogenic kyphosis in 4 cases(7.69%),spondylitis in 2 cases(3.85%),spinal related tumors in 2 cases(3.85%),non-specific spinal infection in 1 case(1.92%).The clinical symptoms included back pain in 52 cases(100.00%),body forward tilt in 42 cases(80.77%),fatigue in 33 cases(63.46%)and walking difficulty in 18 cases(34.62%).The complications included spinal stenosis in 12 cases(23.08%),lumbar disc herniation in 10 cases(19.23%),old vertebral fracture in 5 cases(9.62%),and thoracolumbar compression fracture in 5 cases(9.62%).After treatment,the thoracic kyphosis angle(23.59±3.82)°,lumbar lordosis angle(44.52±7.86)°,pelvic inclination angle(57.36±4.64)°and sagittal vertical axis(4.21±1.02)cm were all significant better than(19.84±5.86)°,(28.56±10.18)°,(65.86±6.68)°and(6.34±3.69)cm before treatment,and the difference was statistically significant(P<0.05).The VAS score of patients was(6.67±2.86)points before treatment,and(3.62±1.56)points after treatment.The VAS score after treatment of patients was significantly lower than that before treatment,and the difference was statistically significant(t=6.7512,P=0.0000<0.05).Conclusion There are many risk factors for sagittal spinal imbalance in elderly patients.The main clinical symptoms of patients are pain and forward tilt,which are easy to be complicated with spinal stenosis,disc herniation,old verteb

关 键 词：脊柱矢状位失衡 常规综合治疗 影像学 骨质疏松 

分 类 号：R687.3[医药卫生—骨科学]