CAJ | 학술논문

目的：评价采用经后路椎弓根截骨内固定治疗老年骨质疏松陈旧性胸腰椎压缩骨折伴后凸畸形患者的临床效果。方法2009年8月至2014年2月采用经后路椎弓根截骨内固定术治疗20例老年骨质疏松性陈旧胸腰椎压缩骨折伴后凸畸形的患者，通过X线片观察Cobb角改善情况，采用VAS评分评价患者疼痛情况，采用Frankel分级标准评价患者脊髓功能情况。结果手术时间平均214 min；术中出血量平均753 mL；术前胸腰椎后凸Cobb角平均（43.5±7.2）°，术后第5天Cobb角平均（3.7±1.8）°，较术前明显改善（P﹤0.05），矫正率平均91.5%；术前VAS评分平均（8.6±1.3）分，术后VAS评分平均（2.2±1.1）分，较术前明显改善（ P﹤0.05）；脊髓功能Frankel分级，1例C级患者改善为D级，2例D级患者改善为E级，1例由E级变为D级。末次随访时Cobb角平均（5.7±2.5）°，与术后第5天时比较差异无统计学意义（P﹥0.05），矫形角度丢失平均为（1.9±1.1）°，纠正丢失率5.1%；影像学显示植骨融合，未见内固定断裂、松动现象。结论采用后路椎弓根截骨内固定治疗老年骨质疏松陈旧性胸腰椎压缩骨折伴后凸畸形可以取得良好的临床效果。
목적：평개채용경후로추궁근절골내고정치료노년골질소송진구성흉요추압축골절반후철기형환자적림상효과。방법2009년8월지2014년2월채용경후로추궁근절골내고정술치료20례노년골질소송성진구흉요추압축골절반후철기형적환자，통과X선편관찰Cobb각개선정황，채용VAS평분평개환자동통정황，채용Frankel분급표준평개환자척수공능정황。결과수술시간평균214 min；술중출혈량평균753 mL；술전흉요추후철Cobb각평균（43.5±7.2）°，술후제5천Cobb각평균（3.7±1.8）°，교술전명현개선（P﹤0.05），교정솔평균91.5%；술전VAS평분평균（8.6±1.3）분，술후VAS평분평균（2.2±1.1）분，교술전명현개선（ P﹤0.05）；척수공능Frankel분급，1례C급환자개선위D급，2례D급환자개선위E급，1례유E급변위D급。말차수방시Cobb각평균（5.7±2.5）°，여술후제5천시비교차이무통계학의의（P﹥0.05），교형각도주실평균위（1.9±1.1）°，규정주실솔5.1%；영상학현시식골융합，미견내고정단렬、송동현상。결론채용후로추궁근절골내고정치료노년골질소송진구성흉요추압축골절반후철기형가이취득량호적림상효과。
Objective To evaluate the outcome of vertebral arch wedge osteotomy with internal fixation for old thoraco-lumbar compression fracture and kyphosis in senile osteoporosis patients. Methods Between August 2009 and February 2014, 20 old patients were treated with Vertebral arch wedge osteotomy with internal fixation. The pre-and post-operative Kyphotic Cobb angle,VAS of back pain and Frankel score were accessed. Results The average operative time was 214 min and average bleeding was 753 mL. The average Cobb angle was(43. 5 ± 7. 2)°pre-operatively and(3. 7 ± 1. 8)°post-operatively. There were statistical significant differences between them(P﹤0. 05),with a mean correction rate of 91. 5%. The average VAS of back pain was(8. 6 ± 1. 3)pre-operatively and(2. 2 ± 1. 1)post-operatively,there were statistical significant differences between them(P﹤0. 05). The average Cobb angle was(5. 7 ± 2. 5)°in the last post-operation follow-up,there were not statistical significant differences(P﹥0. 05). The average loss angle was(1. 9 ± 1. 1)°,with a mean losing rate was 5%. No post-operative complications such as artery injury,exacerbation of neurological symptoms. Bony fusion was observed. There were no failure of internal fixation and losing of reduction. Conclusion Vertebral arch wedge osteotomy with internal fixation is effective for old thoracolumbar compression fracture and kyphosis in senile osteoporosis patients.