SRS-SchwabⅤ级截骨在椎体强化术后伤椎再骨折伴脊髓损伤翻修术中的应用  

Application of scoliosis research society-schwab gradeⅤosteotomy in revision of injured vertebral refracture with spinal cord injury after vertebral augmentation

作　　者：高博 吴继功 马华松 邵水霖 陈志明 张乐乐 李海侠 王加旭 黄世博 GAO Bo;WU Ji-gong;MA Hua-song;SHAO Shui-lin;CHEN Zhi-ming;ZHANG Le-le;LI Hai-xia;WANG Jia-xu;HUANG Shi-bo(Department of Spinal Surgery,Characteristic Medical Center of Strategic Support Force,Beijing,100101,China)

机构地区：[1]战略支援部队特色医学中心脊柱外科,北京100101

出　　处：《中国骨与关节杂志》2023年第1期4-11,共8页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金(82172518)。

摘　　要：目的探讨应用SRS-SchwabⅤ级截骨翻修术治疗椎体强化术后伤椎再骨折伴脊髓损伤的疗效、安全性及并发症。方法回顾性分析2013年4月至2020年12月我中心行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)患者共982例,发生伤椎再骨折52例(5.3%),对其中合并脊髓压迫损伤症状并符合纳入标准的9例病历资料进行研究,其中男6例,女3例,年龄69~86岁,平均(75.56±5.87)岁。术前神经功能Frankel分级B级1例,C级5例,D级3例。对比翻修手术前后及随访时的后凸Cobb’s角、疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI),并观察神经功能转归及并发症。结果9例均顺利完成SRS-SchwabⅤ级截骨。截骨部位T113例,T125例,L11例。手术时间310~452 min,平均(381.67±45.33)min,术中出血量600~1600 ml,平均(1138.89±317.79)ml。随访时间14~58个月,平均(34.78±13.28)个月。后凸Cobb’s角由翻修术前的(32.56±9.45)°矫正到术后的(9.11±2.98)°(P<0.001),末次随访为(11.89±3.66)°。VAS评分由翻修术前的7.11±0.60减少为术后的2.78±0.67(P<0.001),末次随访时进一步降低为1.89±0.78(P<0.001)。ODI由翻修术前的84.94±7.68改善至术后的43.70±9.62(P<0.001),末次随访时进一步改善为31.36±4.22(P<0.001)。4例随访阶段神经功能恢复至Frankel E级,5例恢复至Frankel D级。翻修手术近期并发症包括脑脊液漏1例,胸腔积液3例,伤口愈合不良1例。远期因内固定松动及脊柱失平衡行再手术2例。结论对于椎体强化术后伤椎再骨折伴脊髓损伤患者,应用SRS-SchwabⅤ级截骨翻修术治疗有一定的近期并发症发生率及远期再手术率,但手术安全可行,总体疗效满意。Objective To investigate the efficacy,safety and complications of SRS-Schwab gradeⅤosteotomy in the treatment for refracture of injured vertebrae with spinal cord injury after vertebral augmentation.Methods From April 2013 to December 2020,982 patients with OVCF underwent percutaneous kyphoplasty in our department.Among them,52 patients(5.3%)suffered from refracture of injured vertebrae,and 9 patients who met the inclusion criteria with symptoms of spinal cord injury were retrospective reviewed.There were 6 males and 3 females with a mean age of(75.56±5.87)years(range:69-86 years).Preoperative neurological function:Frankel grade B in 1 case,grade C in 5 cases and grade D in 3 cases.The kyphosis Cobb’s angle,VAS and ODI score before and after revision surgery and follow-up were compared,and the neurological outcomes and complications were observed.Results SRS-Schwab gradeⅤosteotomy was successfully performed in 9 patients.Osteotomy sites located in T11 in 3 cases,T12 in 5 cases and L1 in 1 case.The mean operation time was(381.67±45.33)min(range:310-452 min);the mean blood loss was(1138.89±317.79)ml(range:600-1600 ml);the mean follow-up was(34.78±13.28)months(range:14-58 months).The kyphosis Cobb’s angle was significantly corrected from(32.56±9.45)°preoperatively to(9.11±2.98)°postoperatively(P<0.001)and(11.89±3.66)°at the last follow-up.The VAS score was significantly decreased from(7.11±0.60)preoperatively to(2.78±0.67)postoperatively(P<0.001)and further to(1.89±0.78)at the last follow-up(P<0.001).ODI score improved from(84.94±7.68)preoperatively to(43.70±9.62)postoperatively(P<0.001)and further to(31.36±4.22)at the last follow-up(P<0.001).The neurological function of 5 patients recovered to Frankel grade E and 4 patients to Frankel grade D during follow-up.The recent complications of revision surgery included cerebrospinal fluid leakage in 1 case,pleural effusion in 3 cases and poor wound healing in 1 case.Reoperation was performed in 2 cases due to loosening of internal fixation and spin

关 键 词：截骨术 脊柱骨折 脊髓损伤 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]