后路短节段钉棒系统结合椎体成形术治疗严重胸腰段骨质疏松性骨折

摘要

目的：探讨后路短节段钉棒系统结合椎体成形术治疗胸腰段骨质疏松性骨折的临床疗效。方法回顾性收集整理2009年8月至2014年10月行后路短节段钉棒系统结合椎体成形术治疗胸腰段骨质疏松性压缩性骨折病例19例。记录手术时间、术中出血量、骨水泥注入量、并发症及骨水泥渗漏情况临床结果，比较患者术前术后的VAS评分、椎体的前后缘高度恢复比及后凸角变化。结果19例患者均获随访，平均随访时间约16.3个月(6月~23月)，患者术前与术后的VAS评分有统计学差异，椎体的前后缘高度恢复有明显差异，后凸角度的变化有统计学差异，所有患者均无切口感染及神经根并发症，有3例骨水泥渗漏，均为侧方渗漏，均无明显神经症状。结论采用后路短节段螺钉系统固定结合球囊扩张注入骨水泥加强前路，治疗严重胸腰段骨质疏松性压缩性骨折，可有效缓解疼痛，即刻达到三柱的稳定，恢复脊柱力线及稳定性，减少内固定失效、伤椎高度丢失和后凸畸形等并发症的发生，是治疗重度骨质疏松压缩性骨折的一种可靠的手术方式。%Objective To investigate the effect of posterior short-segment screw and rod fixation system combined with vertebroplasty for thoracolumbar burst fractures in patients with osteoporosis. Methods The clinical data of thoracolumbar burst fractures of 19 patients including 4 males and 15 females from August 2009 to October 2014 were analyzed retrospectively. All fractures were reduced with pedicle screw system followed by vertebroplasty. VAS scoring systems were used to evaluate the patients' pain and life quality. The height recovery and kyphotic correction of fracture level were measured by lateral X-ray. Results All patients underwent surgery safely without severe complications occurred. The average follow-up time was 16.3 months. There was significant difference ( P<0.05) in VAS score and the loss of the kyphotic angle and vertebra height at 12 months follow-up and post-operation compared with pre-operation , respectively. And also there was significant difference ( P<0.05) in the kyphotic angle and vertebra height compared with pre-operation. The asymptomatic bone cement intravenous leakage occurred in 3 patients. There was no breakage of internal fixations. Conclusions The posterior short-segment screw and rod fixation system combined with vertebroplasty for treating severe thoracolumbar osteoporotic fracture is a safe and effective management. Because the pain can be effectively relieved, and the stability of the three columns can be achieved immediately, and the spinal cord and the stability can be recovered, and the occurrence of complications such as internal fixation failure, height loss of the injured vertebra and deformity of the rear projection can be reduced.