经皮内固定结合椎体成形术治疗骨质疏松性胸腰椎爆裂性骨折

目的 :探讨经皮内固定结合椎体成形术治疗骨质疏松性胸腰椎爆裂性骨折的安全性及临床疗效。方法 :自2011年4月至2014年4月,采用经皮内固定结合椎体成形术治疗32例骨质疏松性胸腰椎爆裂性骨折患者,其中男13例,女19例;年龄60~73岁,平均65.6岁。32例患者均为单节段骨折,其中T_(11) 4例,T_(12) 9例,L_1 16例,L_2 3例。比较术前、术后2 d及末次随访时的伤椎Cobb角、椎体前缘压缩率、椎体后缘压缩率、椎管占位率,并采用视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评定疗效。结果 :手术时间60~120 min,平均65.7 min;术中出血量20~50 ml,平均25.2 ml。切口均Ⅰ期愈合,32例患者均获得随访,时间12~48个月,平均20.6个月。椎体前缘压缩率由术前的(49.70±5.89)%恢复至术后2 d的(6.00±2.10)%,末次随访时的(6.06±1.57)%;椎体后缘压缩率由术前的(17.36±4.11)%恢复至术后2 d的(5.48±1.65)%,末次随访时的(5.68±1.82)%;伤椎Cobb角由术前的(13.34±3.56)°矫正至术后2 d的(2.86±0.95)°,末次随访时的(3.04±0.94)°;椎管占位率由术前的(22.77±5.83)%恢复至术后2 d的(5.02±1.93)%,末次随访时的(5.15±1.93)%;VAS评分由术前的6.84±0.88恢复至术后2 d的1.94±0.72,末次随访时的1.63±0.83;ODI由术前的(77.50±5.10)%恢复至术后2 d的(17.94±4.82)%,末次随访时的(15.63±5.19)%。3例患者出现骨水泥渗漏,所有病例未发现内固定失效及腰背部顽固性疼痛症状。结论:经皮内固定结合椎体成形术可恢复伤椎高度、改善椎管占位、矫正后凸畸形,缓解疼痛、改善生活质量,是治疗骨质疏松性胸腰椎爆裂性骨折安全有效的方法。

Percutaneous vertebroplasty and pedicle screw fixation for osteoporotic thoracolumbar burst fracture

Objective: To explore the safety and clinical effects of percutaneous vertebroplasty and pedicle screw fixation in treating osteoporotic thoracolumbar burst fracture. Methods: From April 2011 to April 2014, 32 patients with osteoporotic thoracolumbar burst fracture were treated with percutaneous vertebroplasty and pedicle screw fixation. There were 13 males and 19 females, aged in ranging from 60 to 73 years old(averaged 65.6 years). All fractures were single thoracolumbar fracture and 4 cases located on T₁₁, 9 on T₁₂, 16 on L₁ and 3 on L₂. Cobb angle, vertebral anterior compression rate, vertebral posterior compression rate, spinal canal occupying ratio were compared, visual analogue scale (VAS) and Oswestry Disability Index(ODI) were analyzed before and after operation. Results: The mean operation time was 65.7 min(ranged, 60 to 120 min) and blood loss was 25.2 ml (ranged, 20 to 50 ml). The operative incisions obtained primary healing. All patients were followed up from 12 to 48 months with an average of 20.6 months. Vertebral anterior compression rate and vertebral posterior compression rate were respectively corrected from preoperative (49.70±5.89)%, (17.36±4.11)% to (6.00±2.10)%, (5.48±1.65)% at 2 d after operation, and (6.06±1.57)%, ( 5.68±1.82)% at last follow-up. Cobb angle and spinal canal occupying ratio were respectively corrected from preoperative (13.34±3.56)°, (22.77±5.83)% to(2.86±0.95)°, (5.02±1.93)% at 2 d after operation, and (3.04±0.94)°, (5.15±1.93)% at last follow-up. VAS and ODI were respectively decreased from preoperative (6.84±0.88)points, (77.50±5.10)% to(1.94±0.72) points, (17.94±4.82)% at 2 d after operation, and (1.63±0.83) points, (15.63±5.19)% at last follow-up. Cement leakage occurred in 3 cases. No internal fixation failure and intractable lower back pain were found. Conclusion: Percutaneous vertebroplasty and pedicle screw fixation could restore vertebral body height, improve spinal canal occupying, correct kyphosis, relieve pain, improve life quality, and it is a safe and effective method in treating osteoporotic thoracolumbar burst fracture.