后路椎体次全切治疗胸腰段椎体成形术椎再骨折的临床疗效

Clinical efficacy of posterior subtotal vertebral body dissection in the treatment of vertebral re-fractures in the thoracolumbar segment with vertebroplasty

目的探究在胸腰段椎体成形术椎再骨折患者中采用后路椎体次全切治疗的临床疗效,并对其进行探讨与分析。方法随机选取2019年1月—2021年1月于我院骨科治疗的胸腰段椎体成形术椎再骨折患者58例作为研究对象。给予患者后路椎体次全切治疗,记录患者的手术时间及术中出血量,对比手术前以及手术后6个月患者的VAS疼痛评分、后凸Cobb角、椎体高度、椎管容积率以及美国脊柱损伤协会(ASIA)损伤分级。结果患者的手术时间为1.4~3.8 h,手术平均时间为(2.45±0.61)h,患者术中出血量为580~1470 mL,术中平均出血量为(835.48±134.75)mL。手术后6个月患者的VAS疼痛评分低于手术前(P<0.05);手术后6个月患者的后凸Cobb角小于手术前(P<0.05);手术后6个月患者的椎体高度和椎管容积率均大于手术前(P<0.05);患者手术前ASIA损伤分级:A级12例、B级14例、C级16例、D级12例、E级4例;患者手术后6个月ASIA损伤分级:A级5例、B级8例、C级13例、D级15例、E级17例。结论在胸腰段椎体成形术椎再骨折患者中采用后路椎体次全切治疗可缓解患者的疼痛感,减小后凸Cobb角,增大椎体高度和椎管容积率以及改善患者的ASIA损伤分级。

Objective To investigate the clinical efficacy of posterior subtotal vertebral dissection in patients with vertebral re-fractures of thoracolumbar segmental vertebroplasty.Methods Fifty-eight patients with thoracolumbar segmental vertebroplasty vertebral re-fractures treated in the orthopedic department of our hospital from January 2019 to January 2021 were randomly selected as study subjects.The patients were treated with posterior subtotal vertebral dissection,and the operating time and intraoperative bleeding of the patients were recorded,and the VAS pain score,posterior convex Cobb angle,vertebral body height,spinal canal volume ratio,and American Spinal Injury Association(ASIA)injury classification were compared in patients before and 6 months after surgery.Results The operating time was 1.4-3.8 hours,with a mean of(2.45±0.61)hours,and the intraoperative bleeding was 580-1470 mL,with a mean of(835.48±134.75)mL.The VAS pain scores at 6 months after surgery were lower than those before surgery(P<0.05);the posterior convex Cobb angle at 6 months after surgery was smaller than that before surgery(P<0.05);the vertebral body height and spinal canal volume ratio at 6 months after surgery were greater than those before surgery(P<0.05).Preoperative ASIA injury grading:12 cases with grade A,14 cases with grade B,16 cases with grade C,12 cases with grade D and 4 cases with grade E;six months after surgery,5 cases with grade A,8 cases with grade B,13 cases with grade C,15 cases with grade D,and 17 cases with grade E.Conclusion Posterior subtotal vertebral body resection could relieve pain of thoracolumbar vertebroplasty fractures,reduce the posterior convex Cobb angle,increase vertebral body height and spinal canal volume,and improve ASIA injury classification.