骨质疏松性椎体爆裂骨折伴迟发性神经功能障碍的外科手术治疗  

Surgical treatment of osteoporotic burst fracture with delayed neurological dysfunction

作　　者：羊刚毅 黄海锋 赵兵 YANG Gang-yi;HUANG Hai-feng;ZHAO Bing(Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院/绵阳市中心医院,四川绵阳621000

出　　处：《颈腰痛杂志》2023年第4期537-540,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的观察骨质疏松性椎体爆裂骨折合并迟发性神经功能障碍患者行后路内固定、减压和经椎弓根植骨治疗的疗效。方法对37例骨质疏松性椎体爆裂骨折伴迟发性神经功能障碍患者行后路手术(减压、内固定、椎弓根植骨),回顾性分析患者围手术期指标、术后并发症、局部后凸矫正、VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)等指标。结果患者术后即刻和末次随访时的脊柱后凸角显著低于术前(P<0.05);末次随访时患者脊柱后凸稍高于术后即刻,但差异均无统计学意义(P>0.05)。所有患者在末次随访时均已骨性愈合。末次随访时,矫正丢失0~2°,平均(1.5±0.3)°,矫正丢失度(10.3±5.7)%。术后3周和末次随访时,患者VAS评分和ODI指数均显著低于术前,且末次随访时患者VAS评分和ODI指数显著低于术后3周(P<0.05)。末次随访时,患者Frankel分级显著优于术前,差异有统计学意义(P<0.05)。结论后路手术(减压、内固定、椎弓根植骨)可有效改善骨质疏松性椎体爆裂骨折合并迟发性神经功能损伤患者的神经功能和临床症状,术后并发症发生率低,后凸矫正维持效果好。Objective To observe the efficacy of posterior internal fixation,decompression and transpedicular bone grafting in the treatment of osteoporotic burst fracture complicated with delayed neurological dysfunction.Methods The clinical data of 37patients with osteoporotic burst fracture with delayed neurological dysfunction who underwent posterior surgery(decompression,internal fixation and pedicle bone grafting)were analyzed retrospectively.The indexes of operation period,postoperative complications,local kyphosis correction,pain score(VAS),Oswestry disability index(ODI)were observed.Results The kyphosis at the immediate postoperative and at the last follow-up was lower than that before the surgery,and the difference was statistically significant(P<0.05).At the last follow-up,the kyphosis was slightly higher than that immediately after the surgery,and there was no statistically significant difference(P>0.05).All patients had bone healed at the last follow-up.The correction loss was 0~2°,the average was(1.5±0.3)°,and the correction loss was(10.3±5.7)%.Three weeks after surgery and at the last follow-up,VAS and ODI of the patients were lower than those before surgery,and at the last follow-up,VAS and ODIof the patients were lower than those three weeks after surgery.The difference was statistically significant(P<0.05).The Frankel classification of patients at the last follow-up was better than that of preoperative,and the difference was statistically significant(P<0.05).Conclusion Posterior surgery(decompression,internal fixation and pedicle bone grafting)can improve the neurological function and clinical symptoms of patients with osteoporotic burst fracture complicated with delayed neurological injury.The incidence of postoperative complications is low and the maintenance effect of kyphosis correction is good.

关 键 词：骨质疏松症 爆裂性骨折 神经功能障碍 后路手术 椎弓根 

分 类 号：R683.2[医药卫生—骨科学]