临时单侧经皮椎弓根螺钉撑开联合PKP治疗椎体后壁破裂骨质疏松椎体压缩骨折

The use of unilateral pedicle screw reduction combined with percutaneous kyphoplasty in the treatment of osteoporotic compression vertebral fracture with disrupted posterior vertebral walls

中文关键词:  椎体压缩骨折  骨质疏松症  椎弓根螺钉  椎体后凸成形术

英文关键词:Osteoporosis  Vertebral compressed fracture  Pedicle screw  Percutaneous kyphoplasty

中文摘要:

  【摘要】 目的：评价临时单侧椎弓根螺钉撑开结合椎体后凸成形术治疗伴椎体后壁破裂的骨质疏松椎体压缩骨折的疗效。方法：选择我院2012年1月～2014年12月收治的35例单节段伴椎体后壁破裂且无神经功能损害的骨质疏松椎体压缩骨折患者，女性30例，男性5例，年龄55～80岁（平均65.5±7.13岁）。损伤节段从T11～L4共35个骨折椎体。均采用术中临时单侧椎弓根螺钉撑开，结合球囊扩张椎体后凸成形术治疗，随访观察治疗效果。影像学观测术前、术后伤椎Cobb角及椎体高度变化情况，采用视觉模拟评分（vasual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）评价患者手术前后的疼痛和功能状况以判断临床疗效。结果：手术时间平均78.33±13.94min，每个病椎注入骨水泥量平均5.10±1.13ml。术中出血平均18.80±5.29ml。术中有2个椎体出现骨水泥渗漏，渗漏方向为椎体侧方1例，椎间隙1例，均无椎管内渗漏。术后随访12～24个月（平均15±5.50个月）。术前伤椎Cobb 角为16.25°±6.50°，伤椎前缘高度为0.62±0.17，伤椎中央高度为0.63±0.09；末次随访时分别为12.26°±5.14°，0.71±0.11和0.70±0.14，较术前明显改善（P＜0.05）；术前VAS为8.03±1.61分，ODI 为0.73±0.17；末次随访时分别为0.60±0.74分和0.10±0.04，较术前明显改善（P＜0.05）。结论：伴有椎体后壁骨折的骨质疏松椎体压缩骨折，应用经皮邻椎临时椎弓根螺钉撑开结合椎体后凸成形术治疗，恢复椎体高度满意，骨水泥渗漏发生率低，可获得良好的临床疗效。

英文摘要:

  【Abstract】 Objectives: To assess the effectiveness of temporary unilateral pedicle screw reduction combined with percutaneous kyphoplasty as a new procedure for the management of osteoporotic compression vertebral fracture (OVCF) with disrupted posterior vertebral wall (DPVW). Methods: From January 2012 to December 2014, 35 patients with OVCF and DPVW without neurologic damage underwent the proposed procedure in our centre, including 30 females and 5 males with an average age of 65.5±7.13 years (range, 55-80 years). All fractures were single-level, ranging from T11 to L4. For each case, radiographic results (Cobb angle and the height of vertebrae), the pain score and daily function were compared before and after surgery. Results: On average, the surgery time was 78.33±13.94 minutes, the volume of cement injected was 5.10±1.13ml, and the blood loss was 18.80±5.29ml. There were 2 cases of cement leakage, one into the lateral side, the other into the disc space. The average follow-up period was 15±5.50 months(12-24 months). The average preoperative vertebral Cobb angle was 16.25°±6.50°; anterior height was 0.62±0.17 and central height was 0.63±0.09; the correspondent part at final follow-up was 12.26°±5.14°, 0.71±0.11 and 0.70±0.14 successively, which were significantly improved after surgery(P＜0.05). VAS scores of patients were 8.03±1.61, Oswestry disability index was 0.73±0.17, and 0.60±0.74 and 0.10±0.04 successively at final follow-up, which were significantly improved after surgery(P＜0.05). Conclusions: For patients with OVCF and DPVW, temporary unilateral pedicle screw reduction combined with percutaneous kyphoplasty can restore the height of fractured vertebrae, decrease the risk of cement leakage and improve clinical outcome.