脊柱外固定和椎体成形注入骨水泥治疗老年胸腰椎骨折*★

摘要

背景：胸腰椎骨折多采用传统开放复位内固定，其出血多、创伤大。而脊柱外固定器的应用作为微创新技术受到了人们广泛关注。目的：观察新型脊柱外固定联合经皮椎体成形骨水泥注入治疗老年胸腰椎骨折的临床疗效。方法：选择2009年1月至2012年1月治疗的新鲜老年胸腰椎压缩骨折患者33例，先行脊柱外固定器复位，后行经皮椎体成形骨水泥注入。根据影像学资料计算患者治疗前后和末次随访时伤椎前缘高度比、后凸 Cobb 角、椎管占位率和目测类比疼痛评分，随访观察临床疗效。结果与结论：33例患者治疗后、末次随访时伤椎前缘高度比，后凸 Cobb 角、椎管占位率和疼痛目测类比评分较治疗前明显改善，差异有显著性意义(P <0.01)。末次随访与治疗后比较各项指标(除目测类比疼痛评分)差异无显著性意义(P >0.05)。有4例不同程度骨水泥漏，1例脑脊液漏(严密缝合后愈合)。结果可见联合应用脊柱外固定和经皮椎体成形骨水泥注入治疗老年胸腰椎骨折创伤小，且安全有效。%BACKGROUND: Treatment of thoracolumbar fracture with open reduction and internal fixation has been used widely. It is bleeding and injury. As a new technology in the field of minimal y invasive, application of external fixation has been aroused wide concern in spinal fractuers. OBJECTIVE: To explore the clinical effect for the treatment of thoracolumbar fracture of the elderly with external fixation and percutaneous vertebroplasty. METHODS: Thirty-three patients of thoracolumbar compression fractures of the elderly were treated by using spinal external fixator and percutaneous vertebroplasty from January 2009 to January 2012. The patients were treated with spinal external fixator and then treated with percutaneous vertebroplasty. The changes of Cobb angle, anterior height of the vertebral body, the rate of spinal stenosis and visual analogue scale score were measured before and after operation and last fol ow-up. The clinical effect was observed during fol ow-up. RESULTS AND CONCLUSION: The anterior height of the vertebral body, Cobb angle, rate of spinal stenosis and visual analogue scale score post-operation and last fol ow-up were improved when compared with those pre-operation, and the difference was significant (P < 0.01). There were no significant differences in the indicators above (except visual analogue scale score) between post-operation and last fol ow-up (P > 0.05). Four patients had bone cement leakage; one had cerebro-spinal fluid leakage (healing after tight suture). Spinal external fixator combined with percutaneous vertebroplasty is a safe and an effective mini-trauma method for the treatment of thoracolumbar fracture of the elderly.