短节段内固定并椎体成形术治疗重度椎体骨质疏松性骨折伴脊柱后凸畸形

目的 评估行后路内固定并椎体成形术治疗椎体骨质疏松性压缩性骨折的疗效.方法 2007年1月～2011年12月,对32例椎体压缩＞2/3并伴脊柱后凸畸形的老年患者行后路脊柱后凸矫正及椎体成形术.对手术前后患椎高度、脊柱后凸Cobb角、腰背部疼痛视觉模拟量表（visual analog scale,VAS）评分和Oswestry功能障碍指数（Oswestry disability index,ODI）进行评价分析.结果 全部病例平均随访13.5个月.手术前,患椎平均剩余高度为27.8 %,脊柱后凸Cobb角25.3°,腰背痛VAS评分8.06,ODI为90%;术后1周,各项指标分别为63.1%,8.5°,3.14,59.7%;手术后3个月,分别为62.7%,8.69°,1.4,31.32%.与术前相比,差异均有统计学意义（P＜0.05）.结论对于重度椎体骨质疏松性骨折合并脊柱后凸畸形的患者,行脊柱后凸矫正及开放椎体成形术,治疗效果良好.

Short-segment instrumentation with open vertebroplasty for management of severe osteoporotic vertebral compression fractures with spinal kyphosis

Objective To evaluate the potential and outcome of surgical treatment for osteoporotic vertebral compression fractures with local kyphosis by open cement augmentation. Methods From January 2007 to December 2011, 32 patients (mean aged 70.8 years) of severe osteoporosis vertebra compression fractures associated with spinal kyphosis were included in this study, and a total of 33 vertebrae were treated. The severity was defined as that the vertebral body had loss more than 2/3 of its original height. Local kyphosis correction, open kyphoplasty, posterior internal fixation and spinal fusion were applied in all cases. The vertebrae height restoration, kyphotic correction, visual analog scale (VAS)score of back pain and Oswestry disability index (ODI) after surgery were assessed and analyzed. Results The average follow-up period was 13.5 months (ranged from 3 to 45 months). Before the surgery, the mean height leftover of middle body of compressed vertebrae was 27.8%, average Cobb's angle of local kyphosis was 25.3°, VAS score of back pain was 8.06, and ODI was 90%. These parameters increased to 63.1%, 8.5°, 3.14, 59.7% 1 week after operation and to 62.7%, 8.69°, 1.40, 31.32% 3 months after operation respectively. All the parameters were significantly improved 3 months after surgery(P<0.05), and the mean back pain VAS and ODI were also statistic significantly improved when compared with those of 1 week after surgery(P<0.05). Conclusion Local kyphosis correction with open vertebroplasty, posterior internal fixation and spinal fusion has better clinical results than single vertebroplasty in the treatment of severe osteoporotic vertebrae compression fractures, and is recommended for patients of severe osteoporosis vertebra compression fractures associated with spinal kyphosis.