前路椎体切除、融合治疗骨质疏松性椎体骨折塌陷

Treatment of thoracolumbar osteoporotic-fragile fractures with anterior resection of the collapsed vertebra,interbody fusion

目的骨质疏松性椎体骨折塌陷的手术治疗。方法我科从1987年1月—2005年12月,共收治101名胸腰段骨质疏松、创伤后椎体塌陷病人其中男23例,女78例,平均年龄68岁。全部病例均经前路行塌陷椎体切除、畸形矫正、稳定性重建。塌陷椎体显露为左侧胸、腹膜外入路。因为骨质疏松、创伤后椎体塌陷节段通常低于TH,不需开胸即可显露胸腰段脊柱。塌陷椎体的切除用锋利骨刀、咬骨钳、骨凿、刮匙。椎管前壁减压时保留后纵韧带,以减少硬膜外静脉丛出血。压迫神经的塌陷后突骨块从椎管前壁切除。保留骨性终板,彻底刮除软骨终板。椎间撑开矫正后凸畸形。椎体切除处用自体髂骨或钛网或人工椎体加自体骨融合,Kaneda-SR前路器械固定。结果平均手术时间228分钟,失血量850毫升。随访时间平均56个月(3个月—147个月)术前有严重神经功能障碍的84例病人,其中82人神经功能明显改善。术前有大小便功能障碍的59例病人中有44例完全或部分恢复功能。2例病人在矫正进展性后凸畸形后下肢运动功能、膀胱功能无恢复,疼痛缓解不满意,这2例均为不全瘫痪后进展性后凸畸形超过1年病人。结论骨质疏松性椎体骨折,由于骨质缺血坏死、假关节形成,后期出现椎体塌陷,继发严重的神经功能障碍、后凸畸形,治疗的首选措施是前路减压,稳定性重建。

Objective Surgical treatment of thoracolumbar osteoporotic-fragile fractures. Methods Between January 1987 and December 2005 101 patients （23 men and 78 woman） with osteoporotic or posttraumatic vertebral collapse of the thoracic and lumbar spines were surgically in our department. The average age at surgery was 68 years. The procedures used in the treatment of osteoporotic and posttranmatic vertebral cllapse of the thoracolumbar spine were anterior spinal canal decompression by resection of the collapsed vertebra, correction of kyphosis, and reconstruction of anterior column support using a vertebral spacer and anterior instrumentation. Results Operation time was 228 minutes, blood loss was 850ml, and postoperative follow up period was 68 months on the average. Eighty-two of 84 patients showed remarkable neurologic recovery. Of 59 patients with preoperative bladder-bowel disturbance, complete or incomplete recovery occurryed in 44 patients. Two patients who did not show any neurologic recovery in motor function in the lower extremites or the bladder-bowel function in satisfactory pain relief with correction of increasing kyphosis. These two patients kept their paralytic status with increasing kyphosis for over lyear without spinal canal decompression. Conclusion s Treatment of thoracolumbar osteoporotic-fragile fractures with anterior resection of the collapsed vertebra, interbody fusion has excellent clinical results.