Ⅰ期改良后路截骨固定治疗骨质疏松性椎体压缩骨折经皮椎体成形术术后感染的疗效

Efficacy of stage I modified posterior vertebral column resection in the treatment of postoperative infection after percutaneous vertebroplasty for osteoporotic vertebral compression fracture

目的探讨Ⅰ期改良后路截骨固定(mPVCR)治疗骨质疏松性椎体压缩骨折(OVCF)经皮椎体成形术(PVP)术后感染的疗效。方法采用回顾性病例系列研究分析2016年1月至2022年6月郑州市骨科医院收治的11例OVCF行PVP术后感染患者的临床资料,其中男4例,女7例;年龄61~81岁[(70.2±6.4)岁]。损伤节段:T91例,T112例,T123例,L11例,L22例,T11~T121例,T12~L11例。美国脊髓损伤协会(ASIA)分级:D级5例,E级6例。均采用Ⅰ期mPVCR术治疗。记录手术时间、术中出血量。比较术前,术后2周、3个月及末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、病变节段Cobb角;术后2周与末次随访时,病变节段Cobb角丢失情况;末次随访时ASIA分级情况。观察末次随访时感染控制及骨愈合情况、术后并发症发生情况。结果患者均获随访12~44个月[(26.0±9.4)个月]。手术时间和术中出血量分别为230~330 min[(279.2±28.6)min]、500~1100 ml[(840.9±184.1)ml]。术后2周、3个月及末次随访时,VAS分别为(4.0±0.8)分、(2.7±0.9)分、(2.4±0.7)分,均低于术前的(8.1±1.2)分(P<0.01);ODI分别为(45.5±5.1)%、(30.0±6.5)%、(18.5±3.6)%,均低于术前的(78.7±6.2)%(P<0.01);病变节段Cobb角分别为(7.9±1.4)°、(8.5±1.4)°、(9.2±1.5)°,均低于术前的(25.5±9.2)°(P<0.01)。术后3个月VAS、ODI均较术后2周改善(P<0.05),病变节段Cobb角差异无统计学意义(P>0.05);末次随访时ODI较术后3个月进一步改善(P<0.05),VAS、病变节段Cobb角差异均无统计学意义(P>0.05)。末次随访时较术后2周病变节段Cobb角矫正丢失0.96(0.69,1.45)°,病变节段Cobb角矫正丢失率为4.4(2.2,7.4)%。末次随访时,ASIA分级均为E级,患者均可独立正常行走。末次随访时,感染均得到治愈且骨愈合良好。术后2例出现胸腔积液合并肺不张,1例出现切口处脂肪液化,1例发生肺炎。患者均无内固定失败情况发生,且无神经症状加重或死亡等严重并发症。结论Ⅰ期mPVCR治疗OVCF患者PVP术后感染,可明显缓解疼痛及改善功能、矫正畸形、重建脊柱稳定性并彻底清除感染病灶、减少严重并发症。

Objective To explore the efficacy of stage I modified posterior vertebral column resection(mPVCR)in the treatment of postoperative infection after percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF).Methods A retrospective case series study was conducted to analyze the clinical data of 11 OVCF patients with post‑PVP infection who were admitted to Zhengzhou Orthopedics Hospital from January 2016 to June 2022,including 4 males and 7 females,aged 61‑81 years[(70.2±6.4)years].Injured segments included T9 in 1 patient,T11 in 2,T12 in 3,L1 in 1,L2 in 2,T11‑T12 in 1,and T12‑L1 in 1.American Spinal Injury Association(ASIA)grading was grade D in 5 patients and grade E in 6.All the patients were treated with stage I mPVCR.The operation time and intraoperative bleeding volume were recorded.The values of Visual Analogue Scale(VAS),Oswestry Dysfunction Index(ODI),and Cobb angle of the lesion segments before,at 2 weeks,3 months after surgery,and at the last follow‑up were compared.The loss of Cobb angle of the lesion segments at 2 weeks after surgery and at the last follow‑up were compared,and the ASIA grading at the last follow‑up was recorded.The infection control,bone healing,and the incidence of complications were observed at the last follow‑up.Results All the patients were followed up for 12‑44 months[(26.0±9.4)months].The operation time and intraoperative bleeding volume were 230‑330 minutes[(279.2±28.6)minutes]and 500‑1100 ml[(840.9±184.1)ml]respectively.At 2 weeks,3 months after surgery and at the last follow‑up,the VAS scores were(4.0±0.8)points,(2.7±0.9)points,and(2.4±0.7)points respectively,which were all lower than that before surgery[(8.1±1.2)points](P<0.01);the ODI was(45.5±5.1)%,(30.0±6.5)%,and(18.5±3.6)%respectively,which were all lower than that before surgery[(78.7±6.2)%](P<0.01);the Cobb angle of the lesion segments were(7.9±1.4)°,(8.5±1.4)°,and(9.2±1.5)°respectively,which were lower than that before surgery[(25.5±9.2)°](P<0.01).The VAS and ODI were both improved at 3 months after surgery compared with those at 2 weeks after surgery(P<0.05),while there was no significant difference in Cobb angle of the lesion segments(P>0.05).The ODI was further improved at the last follow‑up compared with that at 3 months after surgery(P<0.05),while there were no significant differences in VAS or Cobb angle of the lesion segments(P>0.05).The loss of Cobb angle correction of the lesion segment at the last follow‑up was 0.96(0.69,1.45)°compared with that at 2 weeks after surgery and the rate of loss of Cobb angle correction of the lesion segment was 4.4(2.2,7.4)%.At the last follow‑up,the ASIA grading was grade E for all the patients,who were able to walk normally independently.The infection was all cured and good bony fusion was observed in the operated area at the last follow‑up.Two patients had pleural effusion and pulmonary atelectasis,1 incision fat liquefaction,and 1 pneumonia after the surgery.None of the patients had internal fixation failure and serious complications such as worsening neurological symptoms or death.Conclusion Stage I mPVCR for the treatment of post‑PVP infection in patients with OVCF is proved to attain significant pain relief and functional improvement,good correction results,effective reconstruction of spinal stability,complete removal of infected lesions,and few serious complications.