无神经损伤的老年性胸腰段椎体塌陷的手术治疗

Surgical treatment of senile thoracolumbar vertebral collapse without nerve injury

目的探讨利用侧前方手术入路治疗无神经损伤的老年性骨质疏松骨折后椎体塌陷效果。方法青岛大学附属医院自2015年1月到2018年12月收治的老年骨质疏松骨折后导致椎体塌陷的患者共21例,所有患者术前美国脊髓损伤协会(ASIA)损伤分级均为E级,手术方式均为经侧前方入路一期完成对骨折部位前方结构的重建和后方内固定,且进行了至少12个月的随访,收集患者的一般资料和术前及术后1周及末次随访的视觉模拟评分(Visual Analogue Scale,VAS)、后凸cobb角、伤椎前缘高度压缩百分比、伤椎中央高度压缩百分比、椎体成角,以及手术时间、术中出血量,并持续观察并发症。对重复测量数据采用方差分析。结果手术时间为(4.12±0.74)h,术中出血量为(662.38±115.37)ml,随访时间为(20.33±6.40)个月。患者术后1周、末次随访的VAS评分均较术前显著改善(F=853.022,P<0.05),后凸cobb角、伤椎前缘压缩百分比、伤椎中央压缩百分比及椎体成角在术前与术后及术前与末次随访差异均有统计学意义(P<0.05),术后与末次差异无统计学意义(F=352.704、4691.359、4451.951、5869.033,P>0.05)。结论侧前方手术入路手术创伤小,患者可实现疼痛早期缓解、早期下地。本研究结果显示其对于治疗老年胸腰段无神经损伤性骨质疏松骨折后的椎体塌陷上效果显著,后凸畸形矫正满意,固定牢固,值得推广。

Objective Explore the effect of applying lateral anterior approach to treat senile osteoporotic fractures and vertebral collapse without nerve injury.Methods 21 patients who treated in our hospital between January 2015 to December 2018,with senile osteoporotic thoracolumbar fractures and vertebral collapse,were collected.All were classified as E grade by the American Spinal Injury Association(ASIA)before surgery,and were underwent the lateral anterior approach to complete reconstruction of the anterior structure of the fracture and the posterior internal fixation in one stage,and the follow-up was carried out for at least 12 months.We collect the general information of the patients and the visual analogue scale(VAS),cobb angle,the compression percentage of anterior and central edge of the injured vertebra,the vertebral body angle in the pre-operation,1 week post-operation,and the last follow-up and the operation time,blood loss,and continuous observation of complications.Analysis of Variance was used in repeated measurement data.Results The operation time:(4.12±0.74)hours;the blood loss:(662.38±115.37)ml;the follow-up time(20.33±6.40)months.The VAS in the 1 week post-operation and the the last follow-up were significantly improved compared with the pre-operation(F=853.022,P<0.05);the cobb angle,the compression percentage of the anterior and central edge of the injured vertebra,and the vertebral body angle were significantly different(P<0.05)between pre-and post-operation,and between pre-operation and the last follow-up.There was no significantly different(P>0.05)between post-operation and the last follow-up(F=352.704,4691.359,4451.951,5869.033).Conclusion The lateral anterior approach has less surgical trauma,and patients can achieve early pain relief and early landing.This study found that the approach has a significant efficacy on the treatment of senile osteoporotic thoracolumbar fractures and vertebral collapse without nerve injury,satisfactory correction of kyphosis,and firm fixation.It is an approach worth promoting.