开放后凸成形术联合椎管减压治疗高龄骨质疏松脊柱爆裂骨折

Open kyphoplasty and decompressive laminectomy for osteoporotic vertebral burst fractures in the elderly patients

目的探讨开放后凸成形术治疗高龄骨质疏松脊柱爆裂骨折（OBVF）的疗效。方法对自2005年9月至2010年6月治疗且获得随访的21例高龄OBVF患者资料进行回顾性分析，男8例，女13例；年龄72～89岁，平均80．4岁。所有患者均行椎板切除椎管减压联合后凸成形术。记录疼痛缓解程度【视觉模拟评分（VAS）】、围手术期手术失血量、手术时间、脊柱功能改善[Oswestry功能指数（ODI）评分]及并发症发生情况；比较术前、术后7d、末次随访时的VAS评分、ODI评分及后凸Cobb角情况。结果所有患者术后获3～27个月（平均10．5个月）随访，手术失血量平均238mL，手术时间平均85min。术前合并神经功能障碍患者术后均得到恢复。发生骨水泥外渗5例，切口脂肪液化2例，脑脊液漏1例，无脊髓及神经损伤等严重并发症。术前1d、术后7d、末次随访时VAS评分平均分别为（7．2±1．2）、（2．3±0．5）、（2．8±0．3）分，ODI评分平均分别为（70．5±5．8）、（30．2±3．0）、（32．7±1．5）分，Cobb角平均分别为22．5°±3．5°、16．5°±2．3°、15．8°±1．1°；以上指标术后7d和末次随访时分别与术前比较，差异均有统计学意义（P〈0．05），术后7d与末次随访时比较差异均无统计学意义（P〉0．05）。结论开放后凸成形术联合椎管减压治疗OBVF，术后可迅速缓解疼痛，改善脊柱功能，有效纠正后凸畸形，为高龄、合并症多、无法耐受传统切开复位内固定手术的患者提供了一种安全有效的治疗方法。

Objective To evaluate clinical results of open kyphoplasty combined with decompressive laminectomy for osteoporotic vertebral burst fractures （OVBF） in the ehterly patients. Methods Between September 2005 and June 2010, 21 OVBF patients, 8 men and 13 women, were treated in Beijing Hospital. They were aged from 72 to 89 years （average, 80.4 years）. Open kyphoplasty and decompressive laminectomy was performed for all the patients. Blood loss, surgery time and complications were recorded. Pain was measured preoperatively, postoperatively and al the last follow-up by visual analogue scale （VAS） . Spinal functions were also measured preoperatively, postoperatively and at the last follow-up by the Oswestry Disability Index （ODI） score. Correction of the kyphosis was evaluated by comparing the Cobb＇ s angles before and after operation. Results A mean follow-up of 10. 5 months （from 3 to 27 months） revealed recovery of the preoperative neural dysfunction. The mean blood loss and surgery time were 238 mL 85 minutes respectively. Cement leakage was found in 5 cases, cerebrospinal fluid leakage in one case, and incision liquefaction in 2 cases. No significant spinal or neural complications were observed. On Day one before operation, Day 7 after operation and at the final follow-up, the mean VAS scores were respectively 7.2 ± 1.2, 2.3±0.5 and 2.8±0.3; the mean ODI scores were respectively 70.5±5.8, 30.2±3.0 and 32.7±1.5; the mean Cobb＇ s angles were respectively 22.5°±3.5° , 16.5°±2.3° and 15.8°± 1.1°. There were significant differences between preoperation and postoperation, but no significant differences between postoperative time points. Conclusion Open kyphoplasty and decompressive laminectomy may be a relatively safe and effective treatment for elderly patients with painful OVBF, especially for those who are contraindicated for traditional percutaneous kyphoplasty.