两种手术方案治疗老年骨质疏松性陈旧胸腰椎骨折合并畸形的疗效分析

发布时间：2018-02-05 03:26

本文关键词： 陈旧性胸腰椎骨折后凸畸形脊髓损伤　出处：《中国老年学杂志》2017年19期 　论文类型：期刊论文

【摘要】：目的探讨经前路减压椎体间撑开植骨内固定与经后路截骨矫形手术对高龄骨质疏松性陈旧胸腰椎骨折合并畸形的治疗效果。方法34例合并脊柱后凸畸形的高龄骨质疏松性陈旧胸腰椎骨折患者,分别采取经前路减压椎体间撑开植骨内固定(对照组)与经后路截骨矫形手术(观察组)进行治疗,对比两组患者的手术疗效,观察指标包括术中出血量、手术切口情况、后凸Cobb角评分、SF-36量表以及疼痛视觉评分等。结果对照组患者手术切口较观察组长,术中失血量大,术后伤口引流量更多(P0.05)。功能恢复情况,两组患者Cobb角明显较小,脊柱畸形有效矫正,患者疼痛视觉评分术后明显降低,SF-36量表生活能力均明显提高;以上三个指标在术后1 w、术后1、6个月之间比较差异均有统计学意义(P0.05),而在各个时间点,两组之间差异无统计学意义。结论对于高龄骨质疏松性陈旧胸腰椎骨折合并畸形的治疗,前路手术与后路手术在脊柱畸形的矫正以及减压效果上具有相似的临床效果,可明显改善患者术后生活质量。但是前路手术对于患者身体基础要求较高,术后并发症发生可能性大。
[Abstract]:Objective to investigate the effect of anterior decompression and interbody distraction and internal fixation and posterior osteotomy for the treatment of senile osteoporotic old thoracolumbar fractures with deformities. Methods 34 cases of senile patients with scoliosis were treated. Patients with osteoporotic old thoracolumbar fractures. The patients were treated by anterior decompression and interbody distraction and bone graft fixation (control group) and posterior osteotomy orthopedic surgery (observation group) respectively. Results the operative incision in the control group was larger than that in the observation group, and the blood loss during the operation was larger than that in the control group, the score of Cobb angle of kyphosis was SF-36 and the visual score of pain was higher than that of the control group. After operation, the wound drainage volume was more than P0.05.Functional recovery, the Cobb angle of the two groups was obviously smaller, the spinal deformity was corrected effectively, and the visual score of pain was obviously decreased after operation. The life ability of SF-36 scale was significantly improved. The above three indexes were significantly different between 1 week, 1 month and 6 months after operation (P 0.05), but at each time point. There was no significant difference between the two groups. Conclusion the treatment of senile osteoporotic thoracolumbar fracture with deformity. Both anterior and posterior approaches have similar clinical effects in the correction and decompression of spinal deformities, which can significantly improve the quality of life of patients after operation. The possibility of postoperative complications is high.
【作者单位】：济源市人民医院骨科;重庆医科大学;浙江中医药大学第二附属医院;
【基金】：国家自然科学基金项目支持(No.81371378)
【分类号】：R687.3
【正文快照】： 椎体压缩性骨折是常见的老年骨质疏松性骨折,且多为多发性椎体骨折,部分患者由于长期骨质水平下降,恢复能力弱,导致骨折椎体不愈合,形成严重的脊柱后凸畸形,甚至压迫脊髓而出现迟发型神经受压症状[1]。高龄骨质疏松性胸腰椎骨折常出现骨折不愈合而失去通过保守治疗恢复脊柱结

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