后路减压固定融合术治疗伴椎管侵占的骨质疏松性重度椎体骨折塌陷的疗效评价

【目的】评价后路减压固定融合术治疗伴椎管侵占的骨质疏松性重度椎体骨折塌陷的临床疗效。【方法】回顾性研究2009年1月1日至2014年12月31日收治的27例经后路减压固定融合术治疗的伴椎管侵占的骨质疏松性重度椎体骨折塌陷的患者,全部患者均运用骨水泥强化椎弓根螺钉固定。对比患者术前、术后1周及末次随访时疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、Cobb角及胸腰段Cobb角、神经功能恢复情况(依据Frankel分级评定),记录内固定失败、相邻椎体骨折及骨水泥渗漏等并发症发生情况。【结果】患者平均随访时间27个月,椎体后壁骨折块椎管侵占率为27.41%~63.85%,平均为(43.24±10.61)%。术后VAS、ODI与术前比较,差异均有统计学意义(P0.05)。术后Cobb角、胸腰段Cobb角与术前比较,差异均有统计学意义(P0.05)。Cobb角与胸腰段Cobb角术后矫正率分别为(63.31±23.47)%和(61.91±17.54)%,末次随访时Cobb角与胸腰段Cobb角矫正丢失率分别为(15.38±39.92)%和(21.79±32.20)%,但末次随访时与术后1周比较,差异无统计学意义(P0.05)。末次随访神经功能Frankel分级:D级6例,E级19例,与术前比较,差异无统计学意义(P0.05)。全部病例未发生切口感染,无螺钉松动、断钉或断棒等情况;术后有8例患者发生无症状性骨水泥渗漏;有5例患者再次发生椎体压缩骨折,其中2例发生于相邻节段椎体,3例发生在非相邻节段。【结论】后路减压固定融合术治疗伴有椎管侵占的骨质疏松性重度椎体骨折塌陷,能够有效缓解疼痛、改善脊柱生理功能、重建脊柱稳定性。

Therapeutic Effect of Posterior Decompression,Internal Fixation and Interlaminar Fusion for Severe Osteoporotic Vertebral Fractures and Collapse Complicated with Spinal Canal Encroachment

Objective To evaluate the clinical effect of posterior decompression, internal fixation and interlaminar fusion for the treatment of severe osteoporotic vertebral fracture and collapse complicated with spinal canal encroachment. Methods A retrospective study was carried out in 27 cases of severe osteoporotic vertebral fractures complicated with spinal canal encroachment. The patients were treated with posterior decompression, internal fixation and interlaminar fusion during the period from January 1, 2009 to December 31, 2014. All patients were given vertebral pedicle screw fixation after pedicle augmentation with bone cement. The pain scores of visual analogue scale(VAS), Oswestry Disability Index(ODI), Cobb angle , thoracolumbar Cobb angle and the recovery of neurological function(estimated by Frankel grading system) of the patients were compared beforeoperation, one week after operation and at the end of follow-up. The incidences of internal fixation failure, adjacent vertebral fracture and bone cement leakage also were recorded. Results The patients were followed up for an average of 27 months. The spinal canal occupation rate caused by fracture fragment of posterior vertebral wall was 27.41%~63.85%, with an average of(43.24 ± 10.61)%. Postoperative VAS pain scores, ODI, Cobb angle and thoracolumbar Cobb angle were statistically different from those before operation (P < 0.05). The correction rate for Cobb angle and thoracolumbar Cobb angle was (63.31 ± 23.47)%, (61.91 ± 17.54)%respectively. At the end of the follow-up, the correction loss rate for Cobb angle and the thoracolumbar Cobb angle was (15.38 ± 39.92)%, (21.79 ± 32.20)% respectively, the difference being insignificant compared with those one week after operation(P>0.05). In respect of Frankel grading of neurological function at the end of the follow-up, 6 cases were in grade D and 19 cases were in grade E, but the differences were insignificant compared with those before operation (P > 0.05). None of the patients had surgical site infection, screw looseness or breakage, or rod breakage during the follow-up period. There were 8 patients with asymptomatic bone cement leakage after operation. Vertebral compression fractures recurred in 5 patients, of which 2 had adjacent vertebral fractures and 3 had non -adjacent segment. Conclusion The therapy of posterior decompression, internal fixation and interlaminar fusion is effective for the treatment of severe osteoporotic vertebral fracture and collapse complicated with spinal canal encroachment by obviously relieving pain, improving the physiological function of the spine and stabilizing the spine.