有限截骨短节段固定融合治疗椎体成形术后脊柱后凸畸形  

Treatment of Kyphosis After Vertebroplasty with Limited Osteotomy and Short-Segment Fixation and Fusion

作　　者：张廷伟 于鹏 刘彬 杨凯 毕小媛 姜泽威 李佳佳 周纪平 Zhang Tingwei;Yu Peng;Liu Bin;Yang Kai;Bi Xiaoyuan;Jiang Zewei;Li Jiajia;Zhou Jiping(Department of Spine and Spinal Cord,Wendeng Orthopedic Hospital,Shandong Province,Weihai 264400,China)

机构地区：[1]山东省文登整骨医院脊柱脊髓科,山东威海264400

出　　处：《实用骨科杂志》2024年第11期975-978,共4页Journal of Practical Orthopaedics

摘　　要：目的研究有限截骨短节段椎弓根螺钉内固定治疗椎体成形术后脊柱后凸畸形的临床疗效。方法收集2019年1月至2023年2月于山东省文登整骨医院就诊,椎体成形术后脊柱后凸畸形并伴有严重后背疼痛的患者53例,其中男17例,女36例;年龄60~71岁,平均(67.25±7.18)岁。均采取后路有限脊柱截骨短节段固定融合手术,记录患者手术时间、术中出血量、术后切口引流量、神经功能恢复及并发症发生率,记录术前、术后2周、末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、后凸Cobb角。结果53例患者均获得随访,平均随访(16.25±4.64)个月。手术时间(125.21±66.44)min,术中失血量(550.51±100.32)mL,术后引流量(245.35±56.37)mL。术后2周、末次随访时腰痛VAS评分、ODI指数及后凸Cobb角与术前比较,差异有统计学意义(P<0.01)。末次随访时融合节段Cobb角与术后2周比较有所增大,但差异无统计学意义(P>0.05)。术中发生2例硬膜囊破裂,予以缝合并人工硬脊膜覆盖,术后均无脑脊液漏发生。末次随访时截骨面获得满意融合,所有患者均未出现螺钉松动、断裂等表现。结论有限截骨短节段固定融合治疗椎体成形术后脊柱后凸畸形,能够显著减轻患者疼痛,改善患者脊柱功能状态,纠正脊柱后凸畸形,手术安全有效。Objective To investigate the clinical efficacy of limited osteotomy combined with short-segment fixation and fusion in the treatment of kyphotic deformity that arises after vertebroplasty with pedicle screw fixation.Methods A total of 53 patients with kyphosis and severe back pain following vertebroplasty were enrolled at Wendeng Osteopathic Hospital of Shandong Province from January 2019 to February 2023.The cohort included 17 males and 36 females,aged 60 to 71 years,with a mean age of(67.25±7.18)years.All patients underwent posterior limited spinal osteotomy,short-segment fixation,and fusion surgery.The operation time,intraoperative blood loss,postoperative incision drainage,neurological function recovery,and complication rate were recorded.Additionally,the visual analogue score(VAS),Oswestry disability index(ODI),and kyphotic segmental Cobb angle were documented preoperatively,2 weeks postoperatively,and at the final follow-up.Results All 53 patients completed follow-up,with a mean follow-up duration of(16.25±4.64)months.The mean operation time was(125.21±66.44)minutes,intraoperative blood loss was(550.51±100.32)mL,and postoperative drainage was(245.35±56.37)mL.Statistically significant differences were observed in VAS score,ODI index,and kyphotic Cobb angle at both 2 weeks and the final follow-up(P<0.01).At the final follow-up,the Cobb angle of the fused segment increased slightly compared to 2 weeks postoperatively,but this difference was not statistically significant(P>0.05).During surgery,two cases of dural sac rupture occurred,which were promptly sutured and covered with artificial dura membrane,preventing cerebrospinal fluid leakage postoperatively.At the final follow-up,the osteotomy site was satisfactorily fused,and no screw loosening or fracture was observed in any case.Conclusion Limited osteotomy combined with short-segment fixation and fusion is a safe and effective treatment for kyphosis that develops after vertebroplasty.It significantly reduces pain,improves spinal functionality,and correct

关 键 词：有限截骨 脊柱后凸畸形 椎体成形术 胸腰椎骨折 

分 类 号：R682.13[医药卫生—骨科学]