CAJ | 학술논문

背景：对于椎管内有骨块占位的骨质疏松性胸腰椎爆裂性骨折，单纯椎体成形术难以解除椎管内占位及纠正脊柱后凸畸形，且骨水泥渗漏发生率高，使其成为其应用的相对禁忌证，而传统椎弓根螺钉系统固定存在手术创伤大、螺钉松动及椎体高度丢失等问题。 　　目的：观察经肌间隙入路短节段椎弓根螺钉内固定联合椎体成形治疗单节段胸腰椎骨质疏松性爆裂性骨折的疗效。 　　方法：回顾分析经肌间隙入路短节段椎弓根螺钉内固定联合椎体成形治疗单节段胸腰椎骨质疏松性爆裂性骨折患者31例。内固定后通过疼痛目测类比评分评估腰背部疼痛情况、ODI评分评估腰背部功能情况、SF-36健康调查评分表评估生活质量、胸腰椎正侧位片评估伤椎椎体前缘高度比值、伤椎Cobb角改善情况、Frankel评分评估神经功能情况及并发症。 　　结果与结论：内固定置入过程均顺利完成，未发生脊髓神经损伤。所有患者随访12-36个月，平均24.5个月，伤椎均达满意复位，平均伤椎椎体前缘高度及 Cobb 角得到明显改善，腰背部疼痛明显缓解，腰背部功能明显改善，生活质量明显提高，以上所有指标治疗后均显著改善，与治疗前比较差异有显著性意义(P<0.05)，内固定后1周和内固定后1年比较差异无显著性意义(P>0.05)。内固定后2例患者出现骨水泥渗漏，其中椎体前缘及椎间隙处少量骨水泥渗漏各1例，但均无临床症状。随访期间，无内固定松动、断裂等，无新发骨折。说明联合应用后路经肌间隙入路短节段椎弓根螺钉内固定及伤椎椎体成形，不仅能有效恢复并维持伤椎椎体高度及强度，重建脊柱稳定性，明显缓解腰背部疼痛，还可以使患者获得满意的腰背部功能，显著提高生存质量，是治疗伴椎管内占位的骨质疏松性胸腰椎爆裂性骨折的有效方法。揹景：對于椎管內有骨塊佔位的骨質疏鬆性胸腰椎爆裂性骨摺，單純椎體成形術難以解除椎管內佔位及糾正脊柱後凸畸形，且骨水泥滲漏髮生率高，使其成為其應用的相對禁忌證，而傳統椎弓根螺釘繫統固定存在手術創傷大、螺釘鬆動及椎體高度丟失等問題。 　　目的：觀察經肌間隙入路短節段椎弓根螺釘內固定聯閤椎體成形治療單節段胸腰椎骨質疏鬆性爆裂性骨摺的療效。 　　方法：迴顧分析經肌間隙入路短節段椎弓根螺釘內固定聯閤椎體成形治療單節段胸腰椎骨質疏鬆性爆裂性骨摺患者31例。內固定後通過疼痛目測類比評分評估腰揹部疼痛情況、ODI評分評估腰揹部功能情況、SF-36健康調查評分錶評估生活質量、胸腰椎正側位片評估傷椎椎體前緣高度比值、傷椎Cobb角改善情況、Frankel評分評估神經功能情況及併髮癥。 　　結果與結論：內固定置入過程均順利完成，未髮生脊髓神經損傷。所有患者隨訪12-36箇月，平均24.5箇月，傷椎均達滿意複位，平均傷椎椎體前緣高度及 Cobb 角得到明顯改善，腰揹部疼痛明顯緩解，腰揹部功能明顯改善，生活質量明顯提高，以上所有指標治療後均顯著改善，與治療前比較差異有顯著性意義(P<0.05)，內固定後1週和內固定後1年比較差異無顯著性意義(P>0.05)。內固定後2例患者齣現骨水泥滲漏，其中椎體前緣及椎間隙處少量骨水泥滲漏各1例，但均無臨床癥狀。隨訪期間，無內固定鬆動、斷裂等，無新髮骨摺。說明聯閤應用後路經肌間隙入路短節段椎弓根螺釘內固定及傷椎椎體成形，不僅能有效恢複併維持傷椎椎體高度及彊度，重建脊柱穩定性，明顯緩解腰揹部疼痛，還可以使患者穫得滿意的腰揹部功能，顯著提高生存質量，是治療伴椎管內佔位的骨質疏鬆性胸腰椎爆裂性骨摺的有效方法。
배경：대우추관내유골괴점위적골질소송성흉요추폭렬성골절，단순추체성형술난이해제추관내점위급규정척주후철기형，차골수니삼루발생솔고，사기성위기응용적상대금기증，이전통추궁근라정계통고정존재수술창상대、라정송동급추체고도주실등문제。 　　목적：관찰경기간극입로단절단추궁근라정내고정연합추체성형치료단절단흉요추골질소송성폭렬성골절적료효。 　　방법：회고분석경기간극입로단절단추궁근라정내고정연합추체성형치료단절단흉요추골질소송성폭렬성골절환자31례。내고정후통과동통목측류비평분평고요배부동통정황、ODI평분평고요배부공능정황、SF-36건강조사평분표평고생활질량、흉요추정측위편평고상추추체전연고도비치、상추Cobb각개선정황、Frankel평분평고신경공능정황급병발증。 　　결과여결론：내고정치입과정균순리완성，미발생척수신경손상。소유환자수방12-36개월，평균24.5개월，상추균체만의복위，평균상추추체전연고도급 Cobb 각득도명현개선，요배부동통명현완해，요배부공능명현개선，생활질량명현제고，이상소유지표치료후균현저개선，여치료전비교차이유현저성의의(P<0.05)，내고정후1주화내고정후1년비교차이무현저성의의(P>0.05)。내고정후2례환자출현골수니삼루，기중추체전연급추간극처소량골수니삼루각1례，단균무림상증상。수방기간，무내고정송동、단렬등，무신발골절。설명연합응용후로경기간극입로단절단추궁근라정내고정급상추추체성형，불부능유효회복병유지상추추체고도급강도，중건척주은정성，명현완해요배부동통，환가이사환자획득만의적요배부공능，현저제고생존질량，시치료반추관내점위적골질소송성흉요추폭렬성골절적유효방법。
BACKGROUND:Vertebroplasty alone cannot relief spinal canal encroachment and kyphosis malformation for treatment of osteoporotic thoracolumbar fractures. Moreover, the occurrence rate of bone cement leakage is high, which becomes a contraindication for its application. Pedicle screw internal fixation alone may increase the trauma, screw loosening and high incidence of late kyphosis deformity. OBJECTIVE:To observe the therapeutic effects of short-segment pedicle screw fixation through paraspinal approach combined with vertebroplasty for single-level thoracolumbar osteoporotic burst fractures. METHODS:A retrospective study was conducted in 31 cases receiving short-segment pedicle screw fixation through paraspinal approach combined with vertebroplasty for single-level thoracolumbar osteoporotic burst fractures. After fixation, clinical outcomes were evaluated mainly with use of visual analog scale for lower back pain. Functions of lower back pain were assessed using Oswestry Disability Index questionnaire. Quality of life was evaluated using 36-Item Short Form Health Survey. Thoracolumbar anteroposterior and lateral radiographs were utilized to assess anterior vertebral height ratio and the improvement of Cobb angle. Frankel score was applied to evaluate neurological function and complications. RESULTS AND CONCLUSION:Al operations were successful y completed with no spinal cord or nerve damage. Al patients were fol owed up for a mean 24.5 months (12-36 months). Fractured vertebrae reached satisfactory reduction. The average vertebral body height and Cobb angle significantly improved. The low back pain relieved. Low back function and quality of life improved significantly. Al of the above indicators significantly improved (P<0.05). No significant differences were detected between 1-week postoperation and 1-year postoperation (P>0.05). After fixation, two patients affected bone cement leakage, including one in anterior vertebral body and one in intervertebral space. However, they did not have clinical symptoms. During fol ow-up, no loosening or breakage, no new fractures occurred. These results indicated that the combination of this technique with vertebroplasty plus internal fixation through paraspinal approach not only restored and maintained vertebral height and strength, reconstructed spinal stabilization, obviously lessened low back pain, but also could make patients get satisfactory low back function and improved the quality of life. It is an effective method for osteoporotic thoracolumbar fractures with spinal canal encroachment.