胸腰椎骨质疏松性椎体骨折脊柱融合术的手术疗效：5种典型手术融合技术的综合评估
Surgical outcomes of spinal fusion for osteoporotic vertebral fracture in the thoracolumbar spine: Comprehensive evaluations of 5 typical surgical fusion techniques.
作者信息
Watanabe Kei, Katsumi Keiichi, Ohashi Masayuki, Shibuya Yohei, Hirano Toru, Endo Naoto, Kaito Takashi, Yamashita Tomoya, Fujiwara Hiroyasu, Nagamoto Yukitaka, Matsuoka Yuji, Suzuki Hidekazu, Nishimura Hirosuke, Terai Hidetomi, Tamai Koji, Tagami Atsushi, Yamada Syuta, Adachi Shinji, Yoshii Toshitaka, Ushio Shuta, Harimaya Katsumi, Kawaguchi Kenichi, Yokoyama Nobuhiko, Oishi Hidekazu, Doi Toshiro, Kimura Atsushi, Inoue Hirokazu, Inoue Gen, Miyagi Masayuki, Saito Wataru, Nakano Atsushi, Sakai Daisuke, Nukaga Tadashi, Ikegami Shota, Shimizu Masayuki, Futatsugi Toshimasa, Ohtori Seiji, Furuya Takeo, Orita Sumihisa, Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Kiyasu Katsuhito, Murakami Hideki, Yoshioka Katsuhito, Seki Shoji, Hongo Michio, Kakutani Kenichiro, Yurube Takashi, Aoki Yasuchika, Oshima Masashi, Takahata Masahiko, Iwata Akira, Endo Hirooki, Abe Tetsuya, Tsukanishi Toshinori, Nakanishi Kazuyoshi, Watanabe Kota, Hikata Tomohiro, Suzuki Satoshi, Isogai Norihiro, Okada Eijiro, Funao Haruki, Ueda Seiji, Shiono Yuta, Nojiri Kenya, Hosogane Naobumi, Ishii Ken
机构信息
Department of Orthopaedic Surgery, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata City, 951-8510, Japan.
Department of Orthopaedic Surgery, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata City, 951-8510, Japan.
出版信息
J Orthop Sci. 2019 Nov;24(6):1020-1026. doi: 10.1016/j.jos.2019.07.018. Epub 2019 Aug 21.
BACKGROUND
A consensus on the optimal surgical procedure for thoracolumbar OVF has yet to be reached due to the previous relatively small number of case series. The study was conducted to investigate surgical outcomes for osteoporotic vertebral fracture (OVF) in the thoracolumbar spine.
METHODS
In total, 315 OVF patients (mean age, 74 years; 68 men and 247 women) with neurological symptoms who underwent spinal fusion with a minimum 2-year follow-up were included. The patients were divided into 5 groups by procedure: anterior spinal fusion alone (ASF group, n = 19), anterior/posterior combined fusion (APSF group, n = 27), posterior spinal fusion alone (PSF group, n = 40), PSF with 3-column osteotomy (3CO group, n = 92), and PSF with vertebroplasty (VP + PSF group, n = 137).
RESULTS
Mean operation time was longer in the APSF group (p < 0.05), and intraoperative blood loss was lower in the VP + PSF group (p < 0.05). The amount of local kyphosis correction was greater in the APSF and 3CO groups (p < 0.05). Clinical outcomes were approximately equivalent among all groups.
CONCLUSION
All 5 procedures resulted in acceptable neurological outcomes and functional improvement in walking ability. Moreover, they were similar with regard to complication rates, prevalence of mechanical failure related to the instrumentation, and subsequent vertebral fracture. Individual surgical techniques can be adapted to suit patient condition or severity of OVF.
背景
由于之前病例系列数量相对较少，对于胸腰椎骨质疏松性椎体骨折（OVF）的最佳手术方法尚未达成共识。本研究旨在调查胸腰椎骨质疏松性椎体骨折的手术效果。
方法
总共纳入315例有神经症状且接受了脊柱融合术并至少随访2年的OVF患者（平均年龄74岁；男性68例，女性247例）。根据手术方式将患者分为5组：单纯前路脊柱融合术（ASF组，n = 19）、前后联合融合术（APSF组，n = 27）、单纯后路脊柱融合术（PSF组，n = 40）、后路脊柱融合术联合三柱截骨术（3CO组，n = 92）以及后路脊柱融合术联合椎体成形术（VP + PSF组，n = 137）。
结果
APSF组的平均手术时间更长（p < 0.05），VP + PSF组的术中失血量更低（p < 0.05）。APSF组和3CO组的局部后凸矫正量更大（p < 0.05）。所有组的临床结果大致相当。
结论
所有5种手术方法均产生了可接受的神经学结果以及步行能力的功能改善。此外，它们在并发症发生率、与内固定相关的机械性失败发生率以及随后的椎体骨折方面相似。可根据患者情况或OVF的严重程度调整个体手术技术。
Zotero 插件