CAJ | 학술논문

背景：国内外总结脊柱失平衡的原因包括脊柱畸形、脊柱退变性疾病、骨质疏松椎体压缩性骨折等，作者通过临床研究认为动力性因素(腰背肌)在脊柱矢状面失平衡中起关键作用。目的：通过观察骨质疏松椎体压缩性骨折患者的临床表现和治疗效果，分析脊柱矢状面失平衡的原因。方法：回顾性分析2012年1月至2013年5月收治的骨质疏松压缩性骨折伴脊柱矢状面失平衡患者41例，均在局麻下行经皮穿刺球囊扩张椎体成形治疗。治疗前患者均行骨密度、站立位全脊柱正侧位X射线、以伤椎为中心的CT及MR检查。于患者站立位全脊柱正侧位片中测量伤椎前缘高度、脊柱后凸Cobb角及改善角度、伤椎楔形变角度及改善角度；要求患者行负重试验及行走试验，对比治疗前后数据。结果与结论：治疗前患者出现脊柱矢状面失平衡症状所需行走的距离显著短于治疗后(P<0.05)；治疗前出现脊柱矢状面失平衡负重试验时间亦显著短于治疗后(P <0.05)。在治疗前后站立位全脊柱正侧位片中，Cobb角的平均差值为(10.01±0.76)°，椎体楔形变改善的平均差值为(4.84±0.40)°，差异有显著性意义(P <0.05)。所有患者均获随访，患者腰背部疼痛及矢状面失平衡症状明显缓解。所有患者行经皮球囊扩张椎体成形治疗后无严重并发症发生。提示骨质疏松压缩性骨折部分患者会出现脊柱矢状面失平衡症状，原因并非伤椎楔形变单一因素所致。且患者通过经皮球囊扩张后凸成形治疗后，失平衡症状往往会明显改善，提示脊柱骨折后腰痛限制腰背肌力量是导致脊柱矢状面失平衡的一个重要原因。
배경：국내외총결척주실평형적원인포괄척주기형、척주퇴변성질병、골질소송추체압축성골절등，작자통과림상연구인위동력성인소(요배기)재척주시상면실평형중기관건작용。목적：통과관찰골질소송추체압축성골절환자적림상표현화치료효과，분석척주시상면실평형적원인。방법：회고성분석2012년1월지2013년5월수치적골질소송압축성골절반척주시상면실평형환자41례，균재국마하행경피천자구낭확장추체성형치료。치료전환자균행골밀도、참립위전척주정측위X사선、이상추위중심적CT급MR검사。우환자참립위전척주정측위편중측량상추전연고도、척주후철Cobb각급개선각도、상추설형변각도급개선각도；요구환자행부중시험급행주시험，대비치료전후수거。결과여결론：치료전환자출현척주시상면실평형증상소수행주적거리현저단우치료후(P<0.05)；치료전출현척주시상면실평형부중시험시간역현저단우치료후(P <0.05)。재치료전후참립위전척주정측위편중，Cobb각적평균차치위(10.01±0.76)°，추체설형변개선적평균차치위(4.84±0.40)°，차이유현저성의의(P <0.05)。소유환자균획수방，환자요배부동통급시상면실평형증상명현완해。소유환자행경피구낭확장추체성형치료후무엄중병발증발생。제시골질소송압축성골절부분환자회출현척주시상면실평형증상，원인병비상추설형변단일인소소치。차환자통과경피구낭확장후철성형치료후，실평형증상왕왕회명현개선，제시척주골절후요통한제요배기역량시도치척주시상면실평형적일개중요원인。
BACKGROUND:The reasons for spinal imbalance include spinal deformity, spinal degenerative disease osteoporotic vertebral compression fractures. We believe that the power factor (back muscle) plays a key role in spinal sagittal imbalance. OBJECTIVE:To analyze the reasons for spinal sagittal imbalance by observing clinical manifestations and therapeutic outcomes in patients with osteoporotic vertebral compression fractures. METHODS:A total of 41 patients with osteoporotic compression fractures combined with spinal sagittal imbalance were retrospectively analyzed from January 2012 to May 2013. Al patients were subjected to percutaneous bal oon vertebroplasty under local anesthesia. Before treatment, they received bone density, standing ful-spine lateral X-ray, CT and MR imaging with injured vertebrae as the center. Using standing ful-spine radiographs, the height of anterior border of the injured vertebrae, Cobb angle of kyphosis and improved angle, wedging angle of the injured vertebrae and improved angle were measured. The patients underwent weight loading test and walking test. Preoperative and postoperative data were compared. RESULTS AND CONCLUSION:The patients affected spinal sagittal imbalance symptoms, so the walking distance was significantly shorter than that postoperatively (P<0.05). Moreover, the time of weight loading test was significantly shorter than that postoperatively (P<0.05). In standing ful-spine radiographs, the average difference of Cobb angle was (10.01±0.76)°. The mean difference of vertebral wedging improvement was (4.84±0.40)° (P<0.05). Al patients were fol owed up. Low back pain and sagittal imbalance symptoms were relieved. No severe complications appeared after percutaneous bal oon vertebroplasty. Results indicated that patients with osteoporosis compression fractures can affect the symptoms of spinal sagittal imbalance, which is not only induced by wedging of the injured vertebra. In addition, after percutaneous bal oon vertebroplasty, imbalance symptoms are apparently improved, suggesting that back pain after spinal fracture limits back muscle strength and is an important cause for spinal sagittal imbalance.