后路减压椎体成形短节段融合术治疗骨质疏松性椎体骨折伴脊髓神经损伤的疗效(附45例报道)

摘要

目的 探讨后路减压、椎体成形、短节段内固定、植骨融合术治疗骨质疏松性椎体骨折伴脊髓神经损伤患者的短期疗效.方法 对2015年1月至2017年1月我科收治的45例骨质疏松性椎体骨折伴脊髓神经损伤病例的临床资料进行回顾性分析.患者均行后路减压、椎体成形、短节段内固定、植骨融合术治疗,术后每1～2个月骨科门诊复查1次,采用X线正侧位片检测患者脊柱后凸Cobb角和椎体前缘压缩率,采用VAS评分评价患者疼痛程度,采用JOA评分评价患者腰椎功能,采用Frankel分级标准评价患者脊髓神经功能恢复情况,统计患者并发症发生情况.结果 本组45例患者均获得随访,平均随访时间(9.0 ±2.6)个月.所有手术均顺利完成,无死亡及神经损伤等严重并发症,42例患者术后脊髓神经功能Frankel分级较术前至少改善1级;术后3个月,患者脊柱后凸Cobb角、椎体前缘压缩率及VAS评分较术前均明显降低,JOA评分较术前明显升高,差异有统计学意义(P＜0.05).患者发生切口感染1例、切口延迟愈合1例,脑脊液漏1例,均经对症处理治愈.结论 后路减压、椎体成形、短节段内固定、植骨融合术是一种治疗骨质疏松性椎体骨折伴脊髓神经损伤安全有效的手术方法.%Objective To evaluate the short-term effects of posterior decompression and vertebroplasty with short segment fixation and fusion in the treatment of osteoporotic vertebral fractures with spinal cord injury.Methods A retrospective analysis of 45 cases of osteoporotic vertebral fractures and spinal cord injury admitted in our department from January 2015 to January 2017 was conducted.All patients underwent posterior decom-pression and vertebroplasty with short segment fixation and fusion.X-ray measurements were used to detect the kyphosis angle and vertebral compression ratio.The VAS score was used to evaluate the degree of pain in pa-tients.The JOA score was used to evaluate the lumbar function.Frankel classification criteria were used to e-valuate the recovery of neurological function in patients with spinal cord injury.The incidence of complications was statistically analyzed.Results All 45 patients were followed up for an average of(9.0 ±2.6)months.All the operations were successfully completed without serious complications such as death or nerve injury,and the Frankel classification of spinal nerve function after operation improved in 42 cases.3 months after opera-tion,the Cobb angle,vertebral compression ratio and VAS scores of patients with kyphosis were significantly lower than that of the pre-operation(P＜0.05),and the JOA score was significantly higher than that of the pre-operation(P ＜0.05).There was 1 case of incisional infection,1 case of delayed wound healing and 1 case of cerebrospinal fluid leakage,all of which were cured by symptomatic treatments.Conclusions Pos-terior decompression and vertebroplasty with short segment fixation and fusion is a safe and effective surgical method for osteoporotic vertebral fractures with spinal cord injury.