后外侧植骨融合联合伤椎置钉短节段内固定治疗老年陈旧性胸腰椎骨折伴后凸畸形

摘要

Objective To investigate the senile old thoracolumbar fracture with kyphosis, with back pain as the main performance but without nerve injury, the feasibility of posterolateral fusion with pedicle screw short segment fixation for the treatment. Methods From February 2013 to February 2015, a total of 22 cases of such patients, with postural changes of low back pain as the main performance in standing or sitting, supine relieve pain worse for its characteristics, were not significantly associated with nerve injury. All patients were treated with posterolateral fusion with pedicle screws and short segmental fixation. Results 22 cases were successfully completed surgery, no serious accidents such as cardiopulmonary dysfunction, no complications such as nerve damage. The operation time was 1.2-2.2 h, average 1.6 h. The amount of bleeding was 80-220 ml, average 160 ml. All incisions healed with no complications such as delayed union, nonunion and wound infection. Patients were discharged from hospital after 3-6 days, with an average of 4.2 days. All 20 cases were followed up for an average of 15.2 months. No loosening of screw and screw rod fracture were observed during follow-up. At the last follow-up, the VAS score and ODI index of all patients were significantly improved compared with before operation (P<0.05). There was no significant difference in the Cobb angle between the immediate and final follow-up after surgery (P<0.05), and there was no significant difference between the immediate and final follow-up (P>0.05). Conclusion For senile old thoracolumbar fracture patients with kyphosis deformity, posterior bone grafting and pedicle screw short segment fixation treatment can achieve good effect.%目的 探讨老年陈旧性胸腰椎骨折伴后凸畸形、以腰背痛为主要表现但不伴神经损伤者,采用后外侧植骨融合联合伤椎置钉短节段内固定治疗的可行性.方法 自2013-02-2015-02,收治22例此类患者,均以体位变化性腰背痛为主要表现,以立位或坐位疼痛加重、平卧位减轻为其特点,均未伴有明显的神经损伤症状.所有患者均采用后外侧植骨融合联合伤椎置钉短节段内固定治疗.结果 22例均顺利完成手术,未出现严重的心肺功能障碍等意外情况,无神经损伤等并发症发生;手术时间为1.2-2.2 h,平均1.6 h;术中出血量为80-220 ml,平均160 ml.所有患者切口均一期愈合,无延迟愈合、不愈合和切口感染等并发症发生.患者术后3-6d出院,平均4.2 d.术后共20例获得平均15.2个月的随访,随访期间未见螺钉松动、钉棒断裂等内固定失败.末次随访时,所有患者的VAS评分、ODI指数与术前相比,有显著性改善(P<0.05).其Cobb角在术后即刻与末次随访时,均较术前有显著性改善(P<0.05),且术后即刻与末次随访时比较,差异无显著性(P>0.05).结论 对于陈旧性胸腰椎骨折伴后凸畸形,采用后路植骨、伤椎置钉短节段内固定治疗可取得良好效果.