经皮椎体成形术结合椎弓根螺钉内固定治疗胸腰段骨质疏松性爆裂性骨折

摘要

背景：椎体成形术是治疗骨质疏松性骨折的有效方法，但是对于伴有椎体后壁破裂、椎管内存在压迫的骨折，单纯采用椎体成形并不能够达到满意的治疗效果。目的：探讨经皮椎体成形术（PVP）结合后路椎弓根螺钉内固定术治疗后壁破裂伴椎管内有骨片移位（AO分型：A3/A4）的骨质疏松性椎体骨折（OVCF）的临床疗效。方法：回顾分析2011年5月至2014年9月经CT证实为后壁破裂伴椎管内有骨片移位的椎体骨折患者11例的病例资料。男2例，女9例，年龄55~69岁，平均60.6岁。所有患者均接受PVP+椎弓根螺钉内固定手术，损伤节段：T111例， T124例，L14例，L22例。记录患者术前、术后1周和末次随访的疼痛视觉评分（VAS），Cobb角，椎体前缘、后缘高度。结果：手术均获得成功，2例出现骨水泥泄漏（1例前方泄漏、1例上方泄漏），无经后壁向椎管内泄漏病例。本组患者全部获得随访，时间6~36个月，平均20个月。1例损伤椎上方左侧椎弓根螺钉移位至椎间隙。术前VAS评分，椎体前柱、后柱高度，Cobb角，与术后1周、末次随访时比较，差异均有统计学意义（P＜0.01）。结论：对于有后壁破裂伴椎管内有骨片移位的骨质疏松性椎体骨折，PVP+椎弓根螺钉内固定是一种值得选择的治疗方案。%Background: Percutancons vertebroplasty (PVP) is an effective treatment for osteoporotic vertebral compression fracture (OVCF). But when the OVCF combined with posterior wall rupture accompanied by bone fragment displacement with ver-tebral canal, it is not suitable to use PVP only. Objective:To evaluate therapeutic effects of a combination of PVP and posterior pedicle screw internal fixation for the treat-ment of OVCF with posterior wall rupture accompanied by bone fragment displacement within vertebral canal (AO type:A3/A4). Methods: Eleven patients with OVCF with posterior wall rupture and bone fragment displacement diagnosed by CT scan were involved in this study. There were 2 males and 9 females with a mean age of 60.6 years (range, 55-69 years). Among them, there were 1 case with T11 injury, 4 with T12 injury, another 4 with L1 injury and 2 with L2 injury. PVP and posterior pedicle screw internal fixation were performed in all patients. Pain visual scale (VAS) score, Cobb angle, and the height of anterior and posterior vertebral edge were measured and recorded before surgery, after surgery and at the last follow-up. Results:All surgeries were successfully performed. There were two patients with bone cement leakage (one front leakage and one upper leakage). No leakage from the posterior wall to the spinal canal was found. The mean duration of follow up was 20 months (range, 6-36 months) in all patients. The screw was displaced from the left pedicle above the vertebral body to the intervertebral space in one patient. There were significant differences in VAS score, the height of anterior and posteri-or vertebral edge and Cobb angle before surgery and after surgery, before surgery and the last follow-up (P<0.01). Conclusions:The combination of PVP and pedicle screw internal fixation is an effective treatment for OVCF with posterior wall rupture accompanied by bone fragment displacement within the vertebral canal.