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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。
Objective: To evaluate the effect of temporary unilateral pedicle screw distraction osteotomy combined with kyphoplasty in the treatment of osteoporotic vertebral compression fractures with posterior wall rupture. Methods: Thirty-five cases of osteoporotic vertebral compression fractures with ruptured vertebral body posterior wall ruptured by vertebral body in January 2012 to December 2014 in our hospital were selected. There were 30 female and 5 male, Age 55 to 80 years (mean, 65.5 ± 7.13 years). Injured segments from T11 to L4 a total of 35 fractures of the vertebral body. All patients were treated with temporary unilateral pedicle screw in operation and combined with balloon kyphoplasty. The follow-up results were observed. The changes of Cobb angle and vertebral body height before and after operation were observed by imaging. Vasual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the pain and function of the patients before and after operation Status to determine the clinical efficacy. Results: The average operation time was 78.33 ± 13.94min. The average amount of bone cement injected into each vertebra was 5.10 ± 1.13ml. Intraoperative bleeding average 18.80 ± 5.29ml. There were 2 vertebral bone leakage occurred during surgery, the leakage direction of lateral side of the vertebral body in 1 case, 1 case of intervertebral disc space, no spinal canal leakage. The patients were followed up for 12-24 months (mean 15 ± 5.50 months). The preoperative Cobb angle was 16.25 ° ± 6.50 °, the anterior margin height was 0.62 ± 0.17, and the height of the injured vertebra was 0.63 ± 0.09. The final follow-up was 12.26 ° ± 5.14 °, 0.71 ± 0.11 and 0.70 ± 0.14, respectively (P <0.05). The preoperative VAS was 8.03 ± 1.61 and the ODI was 0.73 ± 0.17. The final follow-up was 0.60 ± 0.74 and 0.10 ± 0.04, respectively, which was significantly improved compared with that before operation (P <0.05) ). CONCLUSION: Osteoporotic vertebral compression fractures with posterior wall fracture of the vertebral body are treated with temporary percutaneous vertebral pedicle screw fixation and kyphoplasty. The vertebral body height is restored and bone cement leakage occurs Low rate of access to good clinical efficacy.