CAJ | 학술논문

目的探讨开放后凸成形术治疗高龄骨质疏松脊柱爆裂骨折(OBVF)的疗效.方法对自2005年9月至2010年6月治疗且获得随访的21例高龄OBVF患者资料进行回顾性分析,男8例,女13例;年龄72～89岁,平均80.4岁.所有患者均行椎板切除椎管减压联合后凸成形术.记录疼痛缓解程度[视觉模拟评分(VAS)]、f围手术期手术失血量、手术时间、脊柱功能改善[Oswestry功能指数(ODI)评分]及并发症发生情况;比较术前、术后7 d、末次随访时的VAS评分、ODI评分及后凸Cobb角情况.结果所有患者术后获3～27个月(平均10.5个月)随访,手术失血量平均238 mL,手术时间平均85 min.术前合并神经功能障碍患者术后均得到恢复.发生骨水泥外渗5例,切口脂肪液化2例,脑脊液漏1例,无脊髓及神经损伤等严重并发症.术前1 d、术后7 d、末次随访时VAS评分平均分别为(7.2±1.2)、(2.3±0.5)、(2.8±0.3)分,ODI评分平均分别为(70.5±5.8)、(30.2±3.0)、(32.7±1.5)分,Cobb角平均分别为22.5°±3.5°、16.5°±2.3°、15.8°±1.1°;以上指标术后7 d和末次随访时分别与术前比较,差异均有统计学意义(P＜0.05),术后7 d与末次随访时比较差异均无统计学意义(P＞0.05).结论开放后凸成形术联合椎管减压治疗OBVF,术后可迅速缓解疼痛,改善脊柱功能,有效纠正后凸畸形,为高龄、合并症多、无法耐受传统切开复位内固定手术的患者提供了一种安全有效的治疗方法.
목적 탐토개방후철성형술치료고령골질소송척주폭렬골절(OBVF)적료효.방법 대자2005년9월지2010년6월치료차획득수방적21례고령OBVF환자자료진행회고성분석,남8례,녀13례;년령72～89세,평균80.4세.소유환자균행추판절제추관감압연합후철성형술.기록동통완해정도[시각모의평분(VAS)]、f위수술기수술실혈량、수술시간、척주공능개선[Oswestry공능지수(ODI)평분]급병발증발생정황;비교술전、술후7 d、말차수방시적VAS평분、ODI평분급후철Cobb각정황.결과 소유환자술후획3～27개월(평균10.5개월)수방,수술실혈량평균238 mL,수술시간평균85 min.술전합병신경공능장애환자술후균득도회복.발생골수니외삼5례,절구지방액화2례,뇌척액루1례,무척수급신경손상등엄중병발증.술전1 d、술후7 d、말차수방시VAS평분평균분별위(7.2±1.2)、(2.3±0.5)、(2.8±0.3)분,ODI평분평균분별위(70.5±5.8)、(30.2±3.0)、(32.7±1.5)분,Cobb각평균분별위22.5°±3.5°、16.5°±2.3°、15.8°±1.1°;이상지표술후7 d화말차수방시분별여술전비교,차이균유통계학의의(P＜0.05),술후7 d여말차수방시비교차이균무통계학의의(P＞0.05).결론 개방후철성형술연합추관감압치료OBVF,술후가신속완해동통,개선척주공능,유효규정후철기형,위고령、합병증다、무법내수전통절개복위내고정수술적환자제공료일충안전유효적치료방법.
Objective To evaluate clinical results of open kyphoplasty combined with decompressive laminectomy for osteoporotic vertebral burst fractures (OVBF) in the elderly patients. Methods Between September 2005 and June 2010,21 OVBF patients,8 men and 13 women,were treated in Beijing Hospital.They were aged from 72 to 89 years (average,80.4 years).Open kyphoplasty and decompressive laminectomy was performed for all the patients.Blood loss,surgery time and complications were recorded.Pain was measured preoperatively,postoperatively and at the last follow-up by visual analogue scale (VAS).Spinal functions were also measured preoperatively,postoperatively and at the last follow-up by the Oswestry Disability Index (ODI) score.Correction of the kyphosis was evaluated by comparing the Cobb's angles before and after operation. Results A mean follow-up of 10.5 months (from 3 to 27 months) revealed recovery of the preoperative neural dysfunction.The mean blood loss and surgery time were 238 mL 85 minutes respectively.Cement leakage was found in 5 cases,cerebrospinal fluid leakage in one case,and incision liquefaction in 2 cases.No significant spinal or neural complications were observed.On Day one before operation,Day 7 after operation and at the final follow-up,the mean VAS scores were respectively 7.2 ± 1.2,2.3 ±0.5 and 2.8±0.3; the mean ODI scores were respectively 70.5±5.8,30.2 ±3.0 and 32.7±1.5;the mean Cobb's angles were respectively 22.5°±3.5°,16.5°±2.3° and 15.8° ± 1.1°.There were significant differences between preoperation and postoperation,but no significant differences between postoperative time points. Conclusion Open kyphoplasty and decompressive laminectomy may be a relatively safe and effective treatment for elderly patients with painful OVBF,especially for those who are contraindicated for traditional percutaneous kyphoplasty.