脊柱畸形矯形術(shù)后近端交界性后凸和交界性失敗的研究進(jìn)展
發(fā)布時(shí)間：2019-03-30 22:11
【摘要】：脊柱畸形患者臨床中并不少見(jiàn),脊柱的后凸或側(cè)凸畸形不但導(dǎo)致軀體矢狀位、冠狀位失平衡,同時(shí)由于腰椎代償性過(guò)度前凸,從而引發(fā)患者頑固性腰背部疼痛,與此同時(shí),還可以造成患者嚴(yán)重的心理負(fù)擔(dān)以及工作和生活上的不便。此外,嚴(yán)重的后凸畸形還可影響患者心肺功能,并可引起脊髓功能損害。因此,矯正脊柱畸形不僅改善患者畸形外觀,更重要的是對(duì)于改善患者心肺功能障礙和緩解神經(jīng)損害起著至關(guān)重要的預(yù)防和治療作用。隨著內(nèi)固定技術(shù)以及各種截骨手術(shù)方式的發(fā)展,不同類型的脊柱畸形得以通過(guò)長(zhǎng)節(jié)段截骨、固定、融合脊柱矯形手術(shù)解除脊柱畸形的神經(jīng)癥狀及矢狀位、冠狀位的失平衡,從而改善患者的生活質(zhì)量。然而,術(shù)后的臨近節(jié)段病變的發(fā)生對(duì)于術(shù)后患者癥狀的恢復(fù)、矯形角度的維持始終存在威脅。在眾多脊柱矯形術(shù)后發(fā)生的并發(fā)癥中,近端交界性后凸和近端交界性失敗可能造成脊柱矢狀面失平衡的加劇或出現(xiàn)嚴(yán)重的神經(jīng)損害,并且部分患者需要手術(shù)干預(yù)才能解決其癥狀,因此受到廣泛關(guān)注。由于PJK和PJF的描述與概念提出時(shí)間較短,在多種脊柱術(shù)后并發(fā)癥中其發(fā)生發(fā)展機(jī)制尚未完全了解。通過(guò)本次對(duì)文獻(xiàn)的系統(tǒng)性回顧,發(fā)現(xiàn)脊柱矯形術(shù)后發(fā)生PJK的危險(xiǎn)因素有:年齡大于55歲;術(shù)前患者嚴(yán)重矢狀面失平衡;前后路聯(lián)合內(nèi)固定手術(shù);長(zhǎng)節(jié)段融合至下腰椎或骶骨;胸廓成形術(shù);采用剛性較強(qiáng)的椎弓根螺釘內(nèi)固定系統(tǒng);肥胖(BMI30)以及骨質(zhì)疏松。發(fā)生機(jī)制為:內(nèi)固定節(jié)段上方廣泛椎旁肌的損傷;棘上韌帶和棘間韌帶(后張力帶)的破壞;端椎選擇不當(dāng);近端椎間盤嚴(yán)重退變;近端椎體壓縮性骨折;近端椎體內(nèi)固的失敗;小關(guān)節(jié)損傷。因此,通過(guò)對(duì)術(shù)后PJK的發(fā)生、發(fā)展的危險(xiǎn)因素和產(chǎn)生機(jī)制的研究,有助于臨床醫(yī)生在手術(shù)前、手術(shù)中和手術(shù)后減少或避免上述危險(xiǎn)因素,從而明顯減少脊柱畸形術(shù)后PJK的發(fā)生率,更好的減輕病人癥狀,提高病人生活質(zhì)量。
[Abstract]:The kyphosis or scoliosis of the spine not only leads to sagittal and coronal imbalance of the body, but also leads to intractable lumbar back pain due to compensatory hyperkyphosis of the lumbar vertebra. It can also cause serious psychological burden and inconvenience to work and life. In addition, severe kyphosis can affect cardio-pulmonary function and cause spinal cord dysfunction. Therefore, the correction of spinal malformations not only improves the appearance of malformations, but also plays an important role in prevention and treatment of cardio-pulmonary dysfunction and nerve damage. With the development of internal fixation technology and various osteotomy methods, different types of spinal malformations can be removed from neurological symptoms and sagittal and coronal imbalance by long segment osteotomy, fixation, and spinal fusion orthopedic surgery. In order to improve the quality of life of patients. However, the occurrence of postoperative adjacent segmental lesions is always a threat to the recovery of symptoms and the maintenance of orthopaedic angle. Among the complications of spinal correction surgery, proximal junction kyphosis and proximal junction failure may result in aggravation of spinal sagittal imbalance or severe neurological damage. And some patients need surgical intervention to solve their symptoms, so it has received extensive attention. Because the description and concept of PJK and PJF have been put forward for a short time, the mechanism of occurrence and development of various postoperative complications of spine has not been fully understood. Through a systematic review of the literature, it was found that the risk factors of PJK after spinal correction included age over 55 years, severe sagittal plane imbalance before and after operation, anterior and posterior combined internal fixation, long segment fusion to lower lumbar vertebrae or sacrum, and severe sagittal plane imbalance before and after operation, and long segment fusion to lower lumbar vertebrae or sacrum. Thoracoplasty; rigid pedicle screw fixation system; obesity (BMI30) and osteoporosis. The mechanism is: injury of extensive paravertebral muscle above internal fixation segment; destruction of supraspinal ligament and interspinous ligament (posterior tension band); inappropriate choice of end vertebra; severe degeneration of proximal intervertebral disc; compression fracture of proximal vertebral body; Failure of internal fixation of the proximal vertebral body; facet joint injury. Therefore, it is helpful for clinicians to reduce or avoid the above-mentioned risk factors before, during and after the operation by studying the risk factors and mechanism of the development of postoperative PJK. Thus, the incidence of PJK after spinal malformations was significantly reduced, the symptoms of patients were alleviated, and the quality of life of the patients was improved.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3
本文編號(hào)：2450534
[Abstract]:The kyphosis or scoliosis of the spine not only leads to sagittal and coronal imbalance of the body, but also leads to intractable lumbar back pain due to compensatory hyperkyphosis of the lumbar vertebra. It can also cause serious psychological burden and inconvenience to work and life. In addition, severe kyphosis can affect cardio-pulmonary function and cause spinal cord dysfunction. Therefore, the correction of spinal malformations not only improves the appearance of malformations, but also plays an important role in prevention and treatment of cardio-pulmonary dysfunction and nerve damage. With the development of internal fixation technology and various osteotomy methods, different types of spinal malformations can be removed from neurological symptoms and sagittal and coronal imbalance by long segment osteotomy, fixation, and spinal fusion orthopedic surgery. In order to improve the quality of life of patients. However, the occurrence of postoperative adjacent segmental lesions is always a threat to the recovery of symptoms and the maintenance of orthopaedic angle. Among the complications of spinal correction surgery, proximal junction kyphosis and proximal junction failure may result in aggravation of spinal sagittal imbalance or severe neurological damage. And some patients need surgical intervention to solve their symptoms, so it has received extensive attention. Because the description and concept of PJK and PJF have been put forward for a short time, the mechanism of occurrence and development of various postoperative complications of spine has not been fully understood. Through a systematic review of the literature, it was found that the risk factors of PJK after spinal correction included age over 55 years, severe sagittal plane imbalance before and after operation, anterior and posterior combined internal fixation, long segment fusion to lower lumbar vertebrae or sacrum, and severe sagittal plane imbalance before and after operation, and long segment fusion to lower lumbar vertebrae or sacrum. Thoracoplasty; rigid pedicle screw fixation system; obesity (BMI30) and osteoporosis. The mechanism is: injury of extensive paravertebral muscle above internal fixation segment; destruction of supraspinal ligament and interspinous ligament (posterior tension band); inappropriate choice of end vertebra; severe degeneration of proximal intervertebral disc; compression fracture of proximal vertebral body; Failure of internal fixation of the proximal vertebral body; facet joint injury. Therefore, it is helpful for clinicians to reduce or avoid the above-mentioned risk factors before, during and after the operation by studying the risk factors and mechanism of the development of postoperative PJK. Thus, the incidence of PJK after spinal malformations was significantly reduced, the symptoms of patients were alleviated, and the quality of life of the patients was improved.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
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