后路短节段固定联合伤椎椎弓根基底部外上缘入路经皮椎体后凸成形术治疗胸腰段骨质疏松性爆裂骨折  

Effect of posterior short-segment fixation plus percutaneous kyphoplasty via the outer upper edge of the base of the fractured vertebral pedicle in the treatment of osteoporotic thoracolumbar burst fracture

作　　者：李国庆[1] 赵华国[1] 孙韶华[1] 马维虎[1] 李豪杰 王扬[1] 陆联松[1] 阮超越 Li Guoqing;Zhao Huaguo;Sun Shaohua;Ma Weihu;Li Haojie;Wang Yang;Lu Liansong;Ruan Chaoyue(Department of Orthopedics,Ningbo No.6 Hospital,Ningbo 315000,China)

机构地区：[1]宁波市第六医院脊柱外科,宁波315000

出　　处：《中华创伤杂志》2022年第7期625-631,共7页Chinese Journal of Trauma

摘　　要：目的探讨后路肌间隙入路经伤椎短节段固定联合伤椎椎弓根基底部外上缘入路经皮椎体后凸成形术(PKP)治疗胸腰段骨质疏松性爆裂骨折的安全性和有效性。方法采用回顾性病例系列研究分析2018年1月至2021年2月宁波市第六医院收治的56例胸腰段骨质疏松性爆裂骨折患者的临床资料,其中男24例,女32例;年龄56~72岁[(63.5±4.6)岁]。患者均采用后路肌间隙入路经伤椎短节段固定联合伤椎椎弓根基底部外上缘入路PKP治疗。记录手术时间、术中出血量、住院时间、手术相关并发症。比较术前、术后2 d及末次随访时腰背部疼痛视觉模拟评分(VAS)、伤椎前缘/中间/后缘高度比及伤椎后凸Cobb角。结果患者均获随访12~28个月[(14.5±2.2)个月]。手术时间为55~85 min[(62.0±12.1)min];术中出血量为80~150 ml[(94.0±18.5)ml];住院时间为5~9 d[(7.4±1.1)d]。术后2 d CT检查示椎旁骨水泥渗漏2例,椎间隙渗漏2例,椎管内渗漏1例,均无相关临床症状。随访期间未见内固定失败及手术相邻节段骨折。术后2 d VAS为(3.2±0.8)分,较术前的(7.5±1.2)分明显降低(P<0.01);末次随访时VAS[(2.2±0.8)分]较术后2 d进一步降低(P<0.01)。术后2 d伤椎前缘/中间/后缘高度比及伤椎后凸Cobb角分别为(89.5±13.2)%、(85.8±7.9)%、(89.5±9.0)%、(5.6±3.2)°,较术前的(48.9±11.8)%、(61.9±11.9)%、(79.9±9.8)%、(26.3±5.6)°明显改善(P均<0.01);末次随访时伤椎前缘/中间/后缘高度比及伤椎后凸Cobb角[(87.0±12.7)%、(82.1±7.8)%、(88.6±10.0)%、(5.4±3.2)°]较术后2 d出现轻微丢失,但差异无统计学意义(P均>0.05)。结论后路肌间隙入路经伤椎短节段固定联合伤椎椎弓根基底部外上缘入路PKP可安全有效治疗胸腰段骨质疏松性爆裂骨折,明显减轻腰背部疼痛,恢复伤椎高度及纠正伤椎后凸畸形。Objective To investigate the safety and efficacy of short-segment fixation covering the fractured vertebrae via posterior intermuscular approach plus percutaneous kyphoplasty(PKP)through the outer upper edge of the base of the fractured vertebral pedicle in the treatment of osteoporotic thoracolumbar burst fracture.Methods A retrospective case series study was used to analyze the clinical data of 56 patients with osteoporotic thoracolumbar burst fracture admitted to Ningbo No.6 Hospital from January 2018 to February 2021,including 24 males and 32 females;aged 56-72 years[(63.5±4.6)years].All patients underwent short-segment fixation covering the fractured vertebrae via posterior intermuscular approach combined with PKP through the outer upper edge of the base of the fractured vertebral pedicle.The operation time,intraoperative blood loss,hospitalization day and surgery-related complications were recorded.The visual analogue score(VAS)of back pain,ratios of the anterior,middle and posterior height of the fractured vertebrae and kyphotic Cobb angle were compared before operation,at postoperative 2 days and at the final follow-up.Results All patients were followed up for 12-28 months[(14.5±2.2)months].The operation time was 55-85 minutes[(62.0±12.1)minutes],intraoperative blood loss was 80-150 ml[(94.0±18.5)ml],and hospitalization day was 5-9 days[(7.4±1.1)days].Based on CT examination at postoperative 2 days,there were 2 patients with paravertebral cement leakage,2 with intervertebral space leakage and 1 with intracanal leakage,but none reported associated clinical symptoms.No implant failure or fractures of adjacent segments was detected during the follow-up period.The VAS was significantly decreased from preoperative(7.5±1.2)points to(3.2±0.8)points at postoperative 2 days(P<0.01),and the score was further lowered to(2.2±0.8)points at the final follow-up when compared with that at postoperative 2 days(P<0.01).The ratios of the anterior,middle and posterior height of the fractured vertebrae and kyphotic Co

关 键 词：骨质疏松 脊柱骨折 椎弓根钉 椎体后凸成形术 

分 类 号：R687.3[医药卫生—骨科学]