陈旧性骨质疏松性椎体压缩骨折继发胸腰椎后凸畸形的开放性手术治疗进展  

Progress in open surgical treatment of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fractures

作　　者：张家豪[1] 袁磊[1] 刘寅昊 倪佳俊 曾岩[1] Zhang Jiahao;Yuan Lei;Liu Yinhao;Ni Jiajun;Zeng Yan(Department of Orthopaedics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191

出　　处：《中华骨科杂志》2023年第7期465-470,共6页Chinese Journal of Orthopaedics

基　　金：北京市自然科学基金(7202230)。

摘　　要：骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)是脊柱骨质疏松最常见的并发症,好发于胸腰椎,可引起骨折部位急慢性疼痛和椎体高度丢失,并可导致进行性后凸畸形。对陈旧性OVCF所致的后凸畸形,开放性手术如前后路减压融合内固定及截骨矫形可以改善局部序列,实现椎体成形术(percutaneous vertebroplasty,PVP)及椎体后凸成形术(percutaneous kyphoplasty,PKP)难以完成的后凸矫形,重建矢状面平衡。由于OVCF患者年龄偏大,部分患者一般情况较差,且骨质疏松导致椎体脆性增高,使手术以及术后内固定失效的风险升高。前路手术存在入路复杂、力学稳定性较差等问题,目前大部分研究集中于后路手术。由于单纯减压固定存在后凸矫正度数的限制,因此需要截骨矫正后凸畸形。对伴有后凸畸形的陈旧性OVCF患者,因骨密度的降低使螺钉把持力下降,而螺钉一旦松动势必影响矫形效果。多数研究采用骨水泥增强椎弓根螺钉治疗,增加了椎体的轴向拔出力,提高了螺钉的稳定性。不同截骨方式的选择是决定患者能否获得良好手术效果的重要因素。Osteoporotic vertebral compression fracture(OVCF)is the most common complication of spinal osteoporosis,mostly occurring in thoracolumbar segment,which can cause acute and chronic pain at the fracture site and loss of vertebral height,and can lead to progressive kyphosis.For kyphosis caused by old OVCF,open surgery such as anterior or posterior decompression and fusion,internal fixation and osteotomy can improve local sequence and achieve satisfactory kyphotic correction which is difficult to complete in percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP),and reconstruct the sagittal balance.Due to the older age of OVCF patients,some of them have poor general conditions.In addition,osteoporosis leads to increased vertebral fragility,which increases the risk of surgery and postoperative internal fixation failure.The anterior approach presents some problems including a complex approach and poor mechanical stability.At present,most studies focus on posterior surgery.Due to the limitation of kyphosis correction by decompression and fixation alone,osteotomy is often required to correct kyphosis.In cases of old OVCF with kyphosis,the screw holding capability decreases due to the decrease of bone mineral density.Additionally,once the screw loosens,the orthopedic effect is inevitably affected.To enhance pedicle screws,most studies have utilized bone cement to increase the axial pullout force of the vertebral body and improve screw stability.The selection from different osteotomy methods is a critical determinant in achieving favorable surgical outcomes for patients.

关 键 词：脊柱骨折 骨质疏松性骨折 脊柱后凸 外科手术 

分 类 号：R687.3[医药卫生—骨科学]