老年性胸腰椎骨质疏松性骨折的分级手术治疗

中华创伤杂志 Pub Date : 2019-08-15 DOI:10.3760/CMA.J.ISSN.1001-8050.2019.08.006

Rui Guo, Youhan Wang, Xiaobin Yang, Lingbo Kong, D. Hao, B. He

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A total of 16 patients had neurological injury, including 14 with grade C and two with grade D according to the American Spinal Injury Association (ASIA) neurological function classification. According to the patient's clinical manifestations and imaging complexity, the patients were assigned with I to V grades for individualized surgical treatment. Among them, 86 patients with grade I were treated with vertebral augmentation; 60 patients with grade II received posterior reduction and internal fixation combined with vertebral augmentation when necessary; 44 patients with grade III were treated with posterior decompression and reduction and internal fixation; 30 patients with grade IV received posterior osteotomy and orthopedic fusion; 18 patients with grade V were treated based on the major symptoms. The visual analogue score (VAS), Oswestry dysfunction index (ODI), vertebral sagittal index, and the American Spinal Injury Association (ASIA) grading before operation and at the last follow-up as well as the postoperative complications were recorded. \n \n \nResults \nAll patients were followed up for 12-38 months with an average of 18.5 months. The VAS of patients with grade I to V improved from preoperative (8.0±0.7)points, (8.1±0.7)points, (8.3±0.89)points, (8.1±0.7)points, (8.2±0.2)points to (2.1±0.8)points, (2.0±0.8)points, (2.2±0.8)points, (2.3±0.8)points, (2.2±0.8)points at the last follow-up (P<0.05); ODI was improved from preoperative 69.5±3.0, 70.1±2.0, 70.3±2.1, 69.9±1.9, 70.0±2.2 to 39.8±2.2, 39.1±2.4, 40.1±2.1, 39.0±2.3, 39.5±2.3 at the last follow-up (P<0.05); the vertebral sagittal index improved from (89.7±2.1)%, (74.4±8.3)%, (75.0±6.7)%, (72.3±5.2)%, (71.1±2.1)% to (85.2±7.4)%, (84.2±5.5)%, (85.1±4.4)%, (86.2±3.5)%, (83.4±1.7)% (P<0.05). For 16 patients with nerve injury, the ASIA grading was improved from preoperative grade C in 14 patients and grade D in two patients to grade D in four patients and grade E in 12 patients at the last follow-up. A total of 11 patients (seven patients with grade I, one with grade II, two with grade IV, and one patient with grade V) had vertebral height loss in the later stage, but only two patients underwent secondary surgery for severe low back pain. \n \n \nConclusions \nFor obsolete thoracolumbar OVCFs, the concept of graded surgery can effectively guide the treatment strategies of these patients. 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引用次数: 0

摘要

目的探讨根据损伤分级手术治疗老年性胸腰椎压缩性骨折(OVCFs)的效果。方法回顾性分析2013年2月至2016年11月西安交通大学医学院附属弘汇医院收治的238例陈旧性胸腰椎ovcf患者的临床资料。男性49人，女性189人，年龄63 ~ 78岁，平均年龄66.8岁。骨密度T值为(-3.8±0.3)SD。35例患者损伤节段位于T7-T9, 171例位于T10-L2, 32例位于L3-L4。根据美国脊髓损伤协会(ASIA)神经功能分级，16例患者发生神经损伤，其中C级14例，D级2例。根据患者的临床表现及影像学复杂程度，将患者分为I ~ V级，进行个体化手术治疗。其中，86例I级患者行椎体增强术;60例II级患者行后路复位内固定，必要时行椎体增强术;44例III级患者行后路减压复位内固定治疗;30例IV级患者行后路截骨矫形融合术;根据主要症状对18例V级患者进行治疗。记录两组患者术前、末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎体矢状指数、美国脊髓损伤协会(ASIA)评分及术后并发症。结果随访12 ~ 38个月，平均18.5个月。I ~ V级患者VAS评分由术前(8.0±0.7)分、(8.1±0.7)分、(8.3±0.89)分、(8.1±0.7)分、(8.2±0.2)分提高至末次随访时(2.1±0.8)分、(2.0±0.8)分、(2.2±0.8)分、(2.3±0.8)分、(2.2±0.8)分(P<0.05);ODI由术前的69.5±3.0、70.1±2.0、70.3±2.1、69.9±1.9、70.0±2.2改善至末次随访时的39.8±2.2、39.1±2.4、40.1±2.1、39.0±2.3、39.5±2.3 (P<0.05);椎体矢状指数改善从(89.7±2.1)%,(74.4±8.3)%,(75.0±6.7)%,(72.3±5.2)%,(71.1±2.1)%(85.2±7.4)%,(84.2±5.5)%,(85.1±4.4)%,(86.2±3.5)%,(83.4±1.7)% (P < 0.05)。在16例神经损伤患者中，ASIA评分从术前的14例C级、2例D级提高到末次随访时的4例D级、12例E级。共有11例患者(7例为I级，1例为II级，2例为IV级，1例为V级)在后期出现椎体高度下降，但只有2例患者因严重腰痛进行了二次手术。结论对于已过时的胸腰椎OVCFs，分级手术理念可有效指导患者的治疗策略。针对不同情况的患者，采用不同的手术方案，可有效缓解疼痛，恢复脊柱稳定性，矫正脊柱后凸畸形，缓解神经压迫，促进功能恢复。关键词:骨质疏松性骨折;脊柱骨折;胸椎;腰椎

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Graded surgery for old thoracolumbar osteoporotic fractures

Objective To investigate the effect of graded surgical treatment according to injury classification on old thoracolumbar vertebral compression fractures (OVCFs). Methods A retrospective case series study was conducted to analyze the clinical data of 238 patients with old thoracolumbar OVCFs admitted to the Honghui Hospital affiliated to the College of Medicine, Xi'an Jiaotong University from February 2013 to November 2016. There were 49 males and 189 females, aged 63-78 years, with an average age of 66.8 years. The bone density T value was (-3.8±0.3)SD. The injured segments were located at T7-T9 in 35 patients, T10-L2 in 171, and L3-L4 in 32. A total of 16 patients had neurological injury, including 14 with grade C and two with grade D according to the American Spinal Injury Association (ASIA) neurological function classification. According to the patient's clinical manifestations and imaging complexity, the patients were assigned with I to V grades for individualized surgical treatment. Among them, 86 patients with grade I were treated with vertebral augmentation; 60 patients with grade II received posterior reduction and internal fixation combined with vertebral augmentation when necessary; 44 patients with grade III were treated with posterior decompression and reduction and internal fixation; 30 patients with grade IV received posterior osteotomy and orthopedic fusion; 18 patients with grade V were treated based on the major symptoms. The visual analogue score (VAS), Oswestry dysfunction index (ODI), vertebral sagittal index, and the American Spinal Injury Association (ASIA) grading before operation and at the last follow-up as well as the postoperative complications were recorded. Results All patients were followed up for 12-38 months with an average of 18.5 months. The VAS of patients with grade I to V improved from preoperative (8.0±0.7)points, (8.1±0.7)points, (8.3±0.89)points, (8.1±0.7)points, (8.2±0.2)points to (2.1±0.8)points, (2.0±0.8)points, (2.2±0.8)points, (2.3±0.8)points, (2.2±0.8)points at the last follow-up (P<0.05); ODI was improved from preoperative 69.5±3.0, 70.1±2.0, 70.3±2.1, 69.9±1.9, 70.0±2.2 to 39.8±2.2, 39.1±2.4, 40.1±2.1, 39.0±2.3, 39.5±2.3 at the last follow-up (P<0.05); the vertebral sagittal index improved from (89.7±2.1)%, (74.4±8.3)%, (75.0±6.7)%, (72.3±5.2)%, (71.1±2.1)% to (85.2±7.4)%, (84.2±5.5)%, (85.1±4.4)%, (86.2±3.5)%, (83.4±1.7)% (P<0.05). For 16 patients with nerve injury, the ASIA grading was improved from preoperative grade C in 14 patients and grade D in two patients to grade D in four patients and grade E in 12 patients at the last follow-up. A total of 11 patients (seven patients with grade I, one with grade II, two with grade IV, and one patient with grade V) had vertebral height loss in the later stage, but only two patients underwent secondary surgery for severe low back pain. Conclusions For obsolete thoracolumbar OVCFs, the concept of graded surgery can effectively guide the treatment strategies of these patients. Different surgical schemes for patients with different conditions can effectively alleviate the pain, restore spinal stability, correct kyphosis deformity, relieve nerve compression and promote functional recovery. Key words: Osteoporotic fractures; Spinal fractures; Thoracic vertebrae; Lumbar vertebrae

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中华创伤杂志

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11327

期刊介绍： Chinese Journal of Trauma (International Standard Serial Publication Number: ISSN 1001-8050, Domestic Uniform Serial Publication Number: CN 50-1098/R) was founded in September 1985, which is the only high-level medical professional academic journal that can comprehensively and systematically reflect the achievements and development trends of China's traumatology medicine, and has a wide academic influence in China's traumatology medicine community. It has a wide range of academic influence in China's trauma medicine. Chinese Journal of Trauma is a source journal of China Science and Technology Paper Statistics, a source journal of China Science Citation Database (CSCD), a core journal of China Comprehensive Medicine and Health Care, a source journal of China Academic Journals Comprehensive Evaluation Database (CAJCED), a full-text journal of China Journal Full-text Database (CJFD), a core academic journal of China Center for Scientific Evaluation (RCCSE), a core academic journal of China Traumatology and Traumatology Center (CTC), a core academic journal of China Traumatology Center (RCCSE). RCCSE) core academic journals; Chinese Biomedical Journal Database (CMCC), Chinese Biomedical Journal Citation Database (CBJCED), China Journal Network (CJN), China Academic Journals (CD-ROM), Chinese Academic Journals Abstracts (Chinese Edition), Chemical Abstracts of the United States (CA), Index Copernicus of Poland (IC), and Japan Institute of Science and Technology Database (JICST), World Health Organization Western Pacific Region Medical Search (WPRIM) and Russian Journal of Abstracts (ΡЖ) included journals.