膨胀式椎弓根钉系统治疗椎体骨质疏松性骨折

目的]探讨膨胀式椎弓根钉系统内固定治疗伴有神经损伤表现的胸腰段椎体骨质疏松性骨折的疗效。方法]本组共有患者31例,平均年龄68.3岁(61～84岁)。术前诊断为胸腰段椎体骨质疏松性骨折并马尾神经或腰神经根损害。全部病例接受了骨折复位、椎管减压、膨胀式椎弓根钉系统内固手术治疗。采用VAS和Oswestry功能障碍指数(ODI),以及影像学观测脊柱Cobb角和受伤椎体高度回复率评估临床疗效。结果]全部患者得到随访,平均随访20.7个月(6～36个月),腰背部疼痛基本消失。术后VAS为2.8分、ODI为32.2%。术后压缩性骨折基本复位,观察期间内固定物无松脱、折断。结论]膨胀式椎弓根钉系统有利于骨质疏松性椎体骨折的复位和维持,进而减轻疼痛症状和提高生存质量,用于伴有神经损伤的老年骨质疏松性椎体骨折是安全和有效的。

Expansive pedicle screw in the treatment of osteoporotic thoracolumbar vertebral fractures with neurological deficit in the elderly

Objective]To evaluate the effects of expansive pedicle screw(EPS) in the treatment of osteoporotic thoracolumbar vertebral fractures with neurological deficit in the elderly.Method]A total of 31 patients with osteoporotic thoracolumbar vertebral compression fractures,including 5 males and 26 females,aged between 61 and 84 years old(average,68.3 years old),were retrospectively reviewed.There were single vertebral osteoporotic fractures with preoperative spinal cord and nerve root compression in all cases.Open operation with EPS fixation placement was adopted.Clinical,imaging and procedure related factors were statistically analyzed.Result]The follow-up period ranged from 6 to 36 months(average,20.7 months).The visual analog score(VAS) and Oswestry disability index(ODI) were 9.1 and 89.7% for preoperative,2.8 and 32.2% for postoperative respectively.There was significant improvement between pre-and post-operative measurement(P<0.05).The height and Cobb’s angle of the fractured vertebra were almost recovered after operation.The internal fixation loosening and breaking were not observed at the follow-up.Conclusion]The open operation with EPS are safe and effective for the osteoporotic thoracolumbar vertebral fractures with neurological deficit in the elderly.