重视骨质疏松与椎旁肌退变对退行性脊柱畸形矫形手术的影响  

Pay attention to the impact of osteoporosis and paraspinal muscle degeneration on the surgery for degenerative spinal deformity

作　　者：朱泽章[1] 邱勇[1] 刘臻[1] Zhu Zezhang;Qiu Yong;Liu Zhen(Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院骨科,脊柱外科,南京210008

出　　处：《中华医学杂志》2025年第9期641-646,共6页National Medical Journal of China

摘　　要：退行性脊柱畸形(DSD)是指由于年龄增长脊柱发生退行性改变,逐渐发展为冠状面/矢状面畸形的疾病。伴有顽固性疼痛、侧后凸进展、神经功能受损的患者应考虑矫形手术治疗,以解除神经受压,同时恢复冠状面和矢状面的脊柱平衡状态。然而,既往手术方案的制定主要参照脊柱影像学参数而忽视了骨质与骨骼肌退变等因素,导致在矢状面形态纠正良好的情况下仍然发生力学并发症。因此临床中需要重视对骨质疏松与椎旁肌退变的综合评估,从而对患者脊柱矢状面平衡状态及术后并发症的风险进行准确预计,并采取相应的手术策略和预防措施,以降低内固定失败的发生率。Degenerative spinal deformity(DSD)refers to a disease in which the spine undergoes degenerative changes due to aging,gradually developing into coronal/sagittal spinal deformities.If the patient has persistent pain,progressive kyphosis,or impaired neurological function,orthopedic surgery should be considered to relieve nerve compression and restore the balance of the coronal and sagittal spine.However,the development of previous surgical plans mainly relied on spinal imaging parameters,while neglecting the importance of bone and skeletal muscle degeneration,resulting in mechanical complications even with good correction of sagittal morphology.Therefore,it is necessary to pay attention to the comprehensive evaluation of osteoporosis and paraspinal muscle degeneration in clinical practice,accurately assess the sagittal balance of the patient′s spine and predict the risk of postoperative complications,and adopt corresponding surgical strategies and preventive measures to reduce the incidence of internal fixation failure.

关 键 词：脊柱 退行性脊柱畸形 骨质疏松 椎旁肌退变 手术 

分 类 号：R68[医药卫生—骨科学]