前路人工椎体重建技术在骨水泥强化手术失败翻修病例中的应用  

Anterior approach for the revision surgery following bone cement augmentation in osteoporotic vertebral compression fractures

作　　者：周一峰 赵兴[2] ZHOU Yi-feng;ZHAO Xing(Medical College of Zhejiang University,Hangzhou 310000,Zhejiang,China;Department of Orthopaedics,Sir Run Run Shaw Hospital,Hangzhou 310016,Zhejiang,China)

机构地区：[1]浙江大学医学院,浙江杭州310000 [2]浙江大学医学院附属邵逸夫医院骨科,浙江杭州310016

出　　处：《中国骨伤》2025年第1期81-86,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨前路伤椎次全切除、骨水泥清除、人工椎体植入、前路或后路内固定在骨质疏松骨折经骨水泥强化治疗失败后需要翻修的病例中的应用及体会。方法:从2020年1月至2021年12月,应用前路手术翻修治疗10例骨水泥强化治疗失败的患者,其中男2例,女8例;年龄55~83岁。翻修原因:术后感染2例,术后神经症状3例,术后椎体塌陷导致后凸畸形5例。其中L_(1)2例,L_(2)4例,L_(3)3例,L_(4)1例。初次经皮椎体成形术(percutaneous vertebroplasty,PVP)2例,经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)8例。二次手术距离初次手术的时间为1~13个月。所有患者伴有不同程度的腰背部疼痛。翻修术前均行X线、CT和MRI检查。记录手术时间、术中出血、手术并发症、Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛视觉模拟评分(visual analogue scale,VAS)。结果:10例均成功施行手术,9例行前路重建+后路经多裂肌最长肌间隙内固定术;1例患者行前路重建+前路钢板内固定术。前路手术时间90~190 min,前路术中出血130~480 ml。所有患者未出现神经损伤、脑脊液漏、大血管损伤、腹腔脏器损伤、切口感染出血等术中及术后并发症。10例获得随访,时间3~20个月。随访期间,所有患者未出现人工椎体移位、切割、松动等并发症。VAS术前4~8分,末次随访2~3分;ODI评分术前17%~37%,末次随访2%~16%。5例后凸畸形翻修角度明显纠正。与手术前比较,VAS和ODI改善。结论:前路椎体次全切除、人工椎体植入,不仅可清除骨水泥,实现有效清创和直接减压;而且重建前中柱支撑,恢复椎体高度和局部曲度,结合椎弓根螺钉内固定,完成了手术节段的稳定性,因此对于骨水泥强化术失败需要翻修的患者,前路手术是一个理想的治疗选择。Objective To observe the clinical outcomes of anterior approach for the revision surgery following unsuccessful bone cement augmentation in osteoporotic vertebral compression fractures.Methods A total of 10 patients who experienced unsuccessful bone cement augmentation underwent anterior revision surgery between January 2020 and December 2021.There were 2 males and 8 females.The age ranged from 55 to 83 years old.The reasons for revision surgery were postoperative infection in 2 cases,postoperative neurological symptoms in 3 cases,and kyphosis resulting from postoperative vertebral collapse in 5 cases.The involved segments included 2 cases of L_(1),4 cases of L_(2),3 cases of L_(3),and 1 case of L_(4).Among them,2 patients underwent primary percutaneous vertebroplasty(PVP),while eight patients underwent primary percutaneous kyphoplasty(PKP).The time interval between the first and second surgeries ranged from 1 to 13 months.All patients presented with varying degrees of lumbar pain.X-ray,CT,and MRI scans were conducted prior to the revision procedure.Surgical duration,intraoperative blood loss,and any complications were documented.Results The surgical procedures were successful in all 10 patients,with 9 cases undergoing anterior reconstruction and posterior internal fixation through the interspace of the multifidus longissimus muscle.One patient underwent anterior reconstruction and anterior plate internal fixation.The duration of the anterior approach surgery ranged from 90 to 190 minutes,with a blood loss volume ranging from 130 to 480 ml.None of the patients experienced any intraoperative or postoperative complications such as nerve injury,cerebrospinal fluid leakage,major vessel damage,abdominal organ injury,incision infection,or bleeding.The follow-up period for 10 patients ranged from 3 to 20 months.Throughout the follow-up,none of the patients experienced complications such as displacement,cutting,or loosening of the artificial vertebral body.Prior to the operation,the visual analogue scale(VAS)ranged from

关 键 词：前路重建 人工椎体 骨质疏松性骨折 骨水泥强化 翻修 

分 类 号：R681.5[医药卫生—骨科学]