骨质疏松性脊柱畸形的临床评价及治疗

目的介绍骨质疏松性椎体变性和病理性椎体骨折。出现脊柱后凸或侧凸畸形，伴发腰腿痛性跛行的临床治疗。方法近4年治疗骨质疏松症伴急剧颈肩痛、腰背痛、进行性驼背畸形患者113例，经规范抗骨质疏松治疗，包括HRT，降钙素，二膦酸盐、钙等，85例，余28例经保守治疗仍有顽固性腰腿痛，选择手术治疗。手术方式：作开窗式中央管或侧隐窝减压，选择性截骨和内固定，恢复神经功能。结果脊柱后凸及侧凸角度小，脊柱矢状面及冠状面X线尚能维持平衡。经抗骨质疏松治疗有效85例。脊柱畸形角度大，伴有顽固性腰腿痛及明显的根性跛行症状且有接受手术治疗的能力，则选择手术治疗。本组平均随访2．2年，均获满意疗效。结论骨质疏松性椎体变性或骨折，影响脊柱负重功能者可选择手术矫形。能使爱压的神经获得减压和重建脊柱的稳定。

Kyphosis or Scoliosis Secondary to Osteoporosis： Clinical Evaluation and Treatment

Objective To introduce the osteoporotic vertebral compression fi＇acture and to make clinical evaluation for its complication： kyphosis or scoliosis deformity and neurological deficiency. Methods 113 patients were treated in our center in these recent 4 years, and all these patients presented osteoporosis and kyphosis or scoliosis secondary to vertebral compression fracture. The main complain were back pain. 85 cases received conservative treatment which including hormone replacement therapy（HRT）, Bisphosphonates, calcitonin and calcium. The other 28 patients presented persistent neurological compromise after a period of medical therapy. So surgical intervention was indicated, which included central canal or lateral recess decompression through laminectomy, selective osteotomy and instrumentation. Results As to patients with small cobb angle on kyphosis or scoliosis and well balanced on sagittal or coronal plane, conservative medical treatment were proved to be effective. For patients presented long term back pain, neurological claudication or other neurological compromise, surgical treatment is recommended if patients condition allowed. Surgical outcomes were acceptable in all these patients at the follow-ups which meaned 2.2 years.Conclusion Vertebral compression fracture which could lead to kyphosis or seoliosis deformity is common seen in osteoporotic patients, surgical correction and decompression is indicated for those with mechanical instability and neurological compromise. The aim of surgery is to release the impinged nerve root and restore the spinal stability and balance.