黄勇兄;梁昌详;庄见雄;昌耘冰;曾时兴;郑晓青;梁国彦;詹世强;

• 1:广东省人民医院广东省医学科学院脊柱外科

摘要(Abstract)：

[目的]比较椎体成形术/后凸成形术(PVP/PKP)、后路Ponte截骨椎板间融合术和后路短缩椎弓根截骨术(PSO)治疗胸腰椎骨质疏松性骨折伴有后凸畸形的临床效果。[方法]回顾分析2009年8月～2017年7月行手术治疗的胸腰交界区脊柱骨质疏松性骨折伴后凸畸形患者40例,男8例,女32例,年龄52-86岁。其中,行PVP/PKP 16例,Ponte截骨17例, PSO截骨7例,比较三种手术的临床效果。[结果] PVP/PKP组的手术时间、术中出血量、住院时间及纠正角度最少,PSO组的手术时间、术中出血量最多, PSO组Cobb角纠正角度最好,Ponte组其次。三组患者末次随访时神经功能Frankel分级均较术前改善,三组患者术后VAS评分均较术前减少,但PVP/PKP组有5例(5/16)术后出现疼痛再发甚至加重或出现神经功能症状,影像检查发现后凸畸形进展,给予翻修手术,行前方或后方减压截骨矫形融合内固定术,术后症状缓解。[结论]对于胸腰交界区脊柱骨质疏松性骨折伴后凸畸形的患者,PVP/PKP手术创伤小但翻修率高,Ponte截骨手术总体效果更好,PSO截骨手术能达到更好的矫形效果但创伤更大,应该综合考虑各种因素决定手术方式。

关键词(KeyWords)： 胸腰椎;骨质疏松性骨折;后凸畸形;手术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 黄勇兄;梁昌详;庄见雄;昌耘冰;曾时兴;郑晓青;梁国彦;詹世强;

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参考文献(References)：

• [1]Bow CH,Cheung E,Cheung CL,et al.Ethnic difference of clinical vertebral fracture risk[J].Osteoporos Int 2012,23(3):879-885.
• [2]Kado DM,Miller-Martinez D,Lui L-Y,et al.Hyperkyphosis,kyphosis progression,and risk of non-spine fractures in older community dwelling women:the study of osteoporotic fractures(SOF)[J].J Bone Miner Res.2014,29(10):2210-2216.
• [3]Sabo A,Hatgis J,Granville M,et al.Multilevel Contiguous Osteoporotic Lumbar Compression Fractures:The Relationship of Scoliosis to the Development of Cascading Fractures[J].Cureus,2017,9(12):e1962.
• [4]Shota T,Yoshihiro M,Noboru H,et al.Major surgical treatment of osteoporotic vertebral fractures in the elderly:a comparison of anterior spinal fusion,anterior-posterior combined surgery and posterior closing wedge osteotomy[J].Asian Spine J,2014,8(3):322-330.
• [5]Huang M-H,Barrett-Connor E,Greendale GA,et al.Hyperkyphotic posture and risk of future osteoporotic fractures:the rancho bernardo study[J].J Bone Miner Res,2006,21(3):419-423.
• [6]Munting E.Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine:indications and technical aspects[J].Eur Spine J,2010,19(Suppl 1):69-73.
• [7]Kaneda K,Asano S,Hashimoto T,et al.The treatment of osteoporotic posttraumatic vertebral collapse using the Kaneda device and bioactive ceramic vertebral prosthesis[J].Spine,1992,17(Suppl):295-303.
• [8]詹世强,周良安,王义生,等.前路手术治疗胸腰段脊柱骨折[J].中国矫形外科杂志,2004,12(10):751-752.
• [9]徐冠华,崔志明,李卫东,等.后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形[J].中国脊柱脊髓杂志,2013,23(2):129-134.
• [10]Shikata J,Yamamuro T,Iida H,et al.Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis[J].Spine,1990,15(5):485-489.
• [11]Uchida K,Kobayashi S,Nakajima H,et al.Anterior expandable strut cage replacement for osteoporotic thoracolumbar vertebral collapse[J].J Neurosurg Spine,2006,4:454-462.
• [12]Suk SI,Kim JH,Lee SM,et al.Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture[J].Spine(Phila Pa1976),2003,28:2170-2175.
• [13]Kashii M,Yamazaki R,Yamashita T,et al.Surgical treatment for osteoporotic vertebral collapse with neurological deficits:retrospective comparative study of three procedures-anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty[J].Eur Spine J,2013,22(7):1633-1642.
• [14]Takahasht T,Hanakita J,Kawaoka T,et.al.Indication for partial vertebral osteotomy and realignment in posterior spinal fixation for osteoporotic thoracolumbar vertebral collapse with neurological deficits[J].Neurol Med Chir,2016,56(8):485-492.
• [15]Du JP,Fan Y,Liu JJ,et al.The analysis of MSTMOVCF(Multisegment thoracolumbar mild osteoporotic fractures surgery or conservative treatment)based on ASTLOF(the assessment system of thoracolumbar osteoporotic fracture)[J].Sci Rep,2018,8:8185.