椎弓根钉固定及高压分步注射椎体成形术治疗老年胸腰椎爆裂骨折并神经损伤

目的探讨椎弓根螺钉内固定结合高压注射椎体成形术治疗老年胸腰椎爆裂性骨折并神经损伤的疗效。方法回顾分析椎弓根螺钉内固定结合经椎弓根高压分步注射骨水泥治疗老年胸腰椎爆裂性骨折并神经损伤患者22例,随访平均19月。术后观察骨折椎体前缘压缩率、椎管侵占率、Cobb角、神经功能改善情况及并发症。结果椎体前缘压缩率由术前的58.7%恢复为术后7.0%,后凸Cobb角由术前平均24.0°矫正至6.6°,椎管侵占率由术前52.6%恢复为术后11.8%,术后与术前比较差异均有统计学意义(P0.01)。VAS术前平均8.7分,术后2.2分。脊髓功能恢复按Frankel分级,除1例A级病例术后截瘫症状无明显恢复外,其他病例均达到1级或1级以上的恢复。有2椎体发生椎体外骨水泥渗漏,无肺栓塞、感染和神经损伤等并发症发生。未发现内固定松动、断裂现象。结论椎弓根螺钉内固定结合椎体成形术有利于同时解决胸腰椎骨折对神经的压迫、脊柱的不稳定及骨质疏松椎体压缩骨折造成的顽固性胸腰背疼痛等问题。高压分步注射可降低骨水泥渗漏的风险。

Pedicle screw fixation and high-pressure cement vertebroplasty for senile thoracolumbar burst fractures with neurological injury

Objective To investigate the clinical efficacy of transpedicular fixation and high-pressure cement vertebroplasty in the treatment of senile thoracolumbar burst fracture with neurological injury.Methods 22 senile patients were retrospectively analyzed who had been treated with transpedicular fixation and high-pressure cement vertebroplasty.All cases were followed up for an average of 19 months and pack ratios of vertebral body,neuropathic-function,invasion ratio of vertebral canal and Cobb angle were analyzed.Results The height of anterior border vertebra was improved from 58.7% preoperatively to 7.0% postoperatively.Invasion ratio of vertebral canal were 52.6% preoperatively and 11.8% postoperatively.The Cobb angle was improved from 24.0°preoperatively to 6.6°postoperatively.The difference was of statistical significance pre-and postoperatively.The VAS was 8.7 points preoperatively and 2.2 points postoperatively.Neurological status improved at least 1 Frankel grade in 21 patients with preoperative incomplete paraplegia.Two cases had cement leakage.No any other complications happened,implant failure were verified at the final radiographic evaluation.Conclusion The operation of pedicle screw fixation combining vertebroplasty is profitable to simultaneously improve nerve compression of thoracolumbar fracture,spine instability,and other chronic pain caused by osteoporotic vertebral compression fracture.Highpressure cement injection step-by-step can significantly reduces the risk of leakage.