腰椎-骨盆平衡对球囊扩张椎体后凸成形术后患者继发邻椎骨折的影响

摘要/Abstract

摘要： 目的探讨腰椎-骨盆平衡对球囊扩张椎体后凸成形术后患者继发邻椎骨折的影响。方法选择2018年1月—2021年5月在广东省东莞市第八人民医院进行诊治的椎体骨折合并腰椎退行性疾病患者86例作为研究对象,所有患者都给予球囊扩张椎体后凸成形术治疗,在术前判断患者的腰椎-骨盆平衡状况,在术前1 d与术后7 d评定与记录患者的Oswestry功能障碍指数（Oswestry Dysfunction Index,ODI）评分;在术后3个月判定患者伤椎和相邻椎间隙前缘高度的丢失情况,包括高度丢失、中度丢失与低度丢失等;在术后1年进行随访,观察患者的邻椎骨折情况。结果在86例患者中,术前腰椎-骨盆平衡60例(腰椎-骨盆平衡组),失衡26例(腰椎-骨盆失衡组)。所有患者顺利痊愈出院,两组术后7 d的ODI评分低于术前1 d,腰椎-骨盆平衡组低于腰椎-骨盆失衡组,差异有统计学意义（P<0.05）。腰椎-骨盆平衡组术后3个月的高度丢失率、中度丢失率与低度丢失率均低于腰椎-骨盆失衡组,差异有统计学意义（P<0.05）。术后随访1年,腰椎-骨盆平衡组的继发邻椎骨折发生率低于腰椎-骨盆失衡组,差异有统计学意义（P<0.05）。结论腰椎-骨盆平衡能降低球囊扩张椎体后凸成形术后患者继发邻椎骨折的发生率,也可减少伤椎和相邻椎间隙前缘高度丢失情况的发生,促进恢复患者的腰椎功能。

关键词: 腰椎-骨盆平衡, 球囊扩张椎体后凸成形术, 继发邻椎骨折, 腰椎功能, 腰椎退行性疾病

Abstract: Objective To investigate the influence of lumbar spine-pelvic balance on the secondary adjacent vertebral fractures after balloon kyphoplasty. Methods From January 2018 to May 2021, 86 patients with vertebral fracture combined with lumbar degenerative disease who were diagnosed and treated in the Eighth People's Hospital of Dongguan City, Guangdong Province were selected as the research objects. All patients were treated with balloon kyphoplasty, and the patient’s lumbar spine-pelvic balance were judged before the operation. The Oswestry Dysfunction Index (ODI) score of the patients was evaluated and recorded 1 day before and 7 days after the operation; the loss of the height of the injured vertebra and the anterior edge of the adjacent intervertebral space was determined 3 months after the operation. Including high loss, moderate loss and low loss; the patients were followed up 1 year after surgery to observe the fracture of adjacent vertebrae. Results Among the 86 patients, there were 60 patients were preoperative lumbar-pelvic balance (balance group) and 26 patients wewre unbalanced (imbalance group). All patients were recovered and discharged smoothly. The ODI scores of the two groups at 7 d after surgery were lower than that of the preoperative 1 d (P<0.05), and the balance group were lower than the imbalance group, the difference is statistically significant (P<0.05). The high loss rate, moderate loss rate, and low loss rate of the balance group were lower than those of the unbalance group at 3 months after operation, the difference is statistically significant (P<0.05). After 1 year of followed-up, the incidence of secondary adjacent vertebral fractures in the balance group were lower than the unbalance group, the difference is statistically significant (P<0.05). Conclusion Lumbar-pelvic balance reduces the incidence of secondary adjacent vertebral fractures in patients after balloon-expandable vertebral kyphoplasty, and can also reduce the occurrence of height loss of the injured vertebrae and the anterior edge of the adjacent intervertebral space, and promote the recovery of the patient’s lumbar spine features.

Key words: lumbar spine-pelvic balance, balloon kyphoplasty, secondary adjacent vertebral fractures, lumbar spine function, lumbar degenerative disease

中图分类号:

R683.2

刘宇涛. 腰椎-骨盆平衡对球囊扩张椎体后凸成形术后患者继发邻椎骨折的影响[J]. 中华养生保健, 2023, 41(9): 54-57.

LIU Yu-tao. Effect of Lumbar Spine-Pelvic Balance on Adjacent Vertebral Fractures after Balloon Kyphoplasty[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(9): 54-57.

参考文献

[1] 王海莹,吕冰,李辉,等.减压植骨融合内固定治疗退变性腰椎滑脱:基于脊柱骨盆参数预测患者的功能预后[J].中国组织工程研究,2021,25(9):1393-1397.
[2] 姚汝斌,王仕永,杨开舜.微创经椎间孔椎间融合治疗单节段腰椎管狭窄症对腰椎-骨盆平衡的改善作用[J].中国组织工程研究,2021,25(9):1387-1392.
[3] 王志伟,韩森东.Roussouly分型及脊柱-骨盆矢状位平衡参数与骨质疏松性椎体骨折预后的相关性分析[J].临床外科杂志,2021,29(1):58-60.
[4] 向杰,范伟杰,唐奕泉,等.经第2骶骨翼髂骨螺钉固定技术在不稳定型骨盆后环损伤治疗中的应用效果分析[J].中华创伤骨科杂志,2022,24(3):206-212.
[5] 王伟炎,夏威威,刘海鹰.退变性脊柱后凸畸形患者腰部肌肉退变与脊柱骨盆参数的相关性分析[J].中国医药,2021,16(3):412-416.
[6] 刘淼淼,吕锐,程薇薇.无症状汉族人群脊柱-骨盆矢状面参数测量影响因素的探索性研究[J].首都医科大学学报,2021,42(1):105-110.
[7] 朱世杰,毛威,叶志炜,等.多节段斜外侧椎间融合术矫正退行性腰椎侧凸的短期临床疗效[J].中国骨与关节杂志,2021,10(1):11-18.
[8] BUCKLAND A J, STEINMETZ L, ZHOU P, et al.Spinopelvic Compensatory Mechanisms for Reduced Hip Motion (ROM) in the Setting of Hip Osteoarthritis[J]. Spine Deform,2019,7(6):923-928.
[9] 林红,董健.退变性腰椎疾病的诊断和治疗[J].临床骨科杂志,2005,8(4):379-382.
[10] 邓波,陈遥,洪正华,等.保留中柱经椎弓根开合式截骨术治疗老年僵硬性脊柱后凸畸形[J].中华骨科杂志,2021,41(1):8-17.
[11] 张鑫,张艳锋.脊柱-骨盆矢状位参数对骨质疏松性椎体压缩骨折患者行非手术治疗后骨折愈合情况的影响[J].颈腰痛杂志,2022,43(1):60-63.
[12] 李腾飞,王业华,王绍龙.腰椎僵直对全髋关节置换术患者姿势性骨盆活动度的影响[J].实用骨科杂志,2022,28(2):109-113.
[13] 钟泽祥,李方财,张宁,等.退行性腰椎侧凸畸形椎旁肌变性及其与腰椎后凸畸形的相关性研究[J].中华骨科杂志,2022,42(7):445-454.
[14] 张鑫,鲍虹达,舒诗斌,等.颈2-股骨头中心位移和骶髂固定对成人脊柱畸形术后近端交界性后凸发生的影响研究[J].中华医学杂志,2022,102(19):1458-1463.
[15] 王经宇,潘长瑜,王孝宾,等.新型腰椎前凸计算回归方程对成人脊柱畸形矫形术后机械性并发症的预测作用[J].中国脊柱脊髓杂志,2022,32(1):20-27.
[16] 潘希安,梁思敏,刘炳霞,等.退变性脊柱侧凸骨盆腰椎匹配值与疗效的相关性[J].中国组织工程研究,2022,26(33):5370-5375.
[17] 钱佳明,王啸,骆园,等.脊柱骨盆参数及骨密度与椎体后凸成形术后邻椎再骨折的相关性[J].中华骨质疏松和骨矿盐疾病杂志,2022,15(1):24-30.
[18] 王凯,刘锐,李学阳.不同部位骨质疏松性椎体压缩骨折行PKP手术后脊柱-骨盆矢状位参数的改善情况分析[J].颈腰痛杂志,2022,43(2):271-274.
[19] 李玉乔,方钊,张东亮,等.退变性及峡部裂性腰椎滑脱患者手术前后矢状位参数与生活质量相关性研究[J].中华医学杂志,2022,102(3):228-234.
[20] 李庆达,贺宝荣,杨俊松,等.老年陈旧性症状性骨质疏松性胸腰椎骨折后路长节段内固定术后近端交界性后凸的危险因素[J].中华创伤杂志,2022,38(2):101-108.