骨质疏松性腰椎骨折合并脊髓损伤的手术治疗

Surgical treatment of lumbar vertebral osteoporotic fractures with spinal cord injuries

目的探讨椎体成形辅助椎弓根螺钉固定治疗骨质疏松性腰椎骨折合并脊髓损伤的临床疗效。方法2006年7月-2007年9月,对7例患者应用此法治疗。平均随访11.6个月（6-20个月）。按ASIA分级标准检查神经功能,用X线片测量伤椎术前、术后后凸畸形的角度和椎体前缘高度进行临床评价。结果7例患者中神经功能由C级恢复到D级4例、恢复到E级1例,由D级恢复到E级2例。伤椎椎体前缘高度压缩率术前为53.00%±9.59%,术后为72.00%±6.70%,丢失4.00%±3.72%（P〈0.01）;后凸畸形角度术前为21.00°±6.57°,术后为8.00°±4.18°（P〈0.01）,丢失2.00°±2.67°（P〈0.05）。7例患者均无骨水泥渗漏,1例出现椎弓根螺钉松动。结论椎体成形辅助椎弓根螺钉固定术是对骨质疏松引起的腰椎骨折合并脊髓损伤的一种有效治疗方法。

Objective To explore the clinical effects of vertebroplasty with pedicle screw fixation on lumbar vertebral osteoporotic fractures with spinal cord injury. Methods From July 2006 to september 2007, 7 cases of lumbar osteoporotic fractures with spinal cord injury underwent vertebroplasty with polymethylmethacrylate （PMMA） and pedicle screw fixation. The mean follow-up period was 11.6 months （ranging from 6 to 20 months）. Radiographic analysis included measurements of kyphotic angulation, anterior vertebral body height. The neurological function were evaluated according to AISA classification： Results The neurological function were improved from C to D in 4 cases, from C to E in 1 case, from D to E in 2 cases. The mean preoperative anterior height of the fractured VB was 53.00% ±9.59% and the postoperative one was 72： 00% ± 6.70% with 4.00% ± 3.72% lost in the follow-up（ P 〈 0.01 ）. The mean preoperative kyphotic deformity was 21.00° ± 6.57° （all values are the mean ± standard deviation） and the postoperative one was 8. 00°± 4.18°（P 〈 0.01 ） with 2.00°± 2.67° lost in the follow-up（P 〈 0.05）. PMMA leakage didn＇ t occurred, and screw loosen was found in 1 case. Conclusion Vertebroplasty with pedicle screw fixation is an effective method in treatment of lumbar vertebral osteoporotic fractures.