后路内固定术结合经皮椎体成形术治疗多节段胸腰椎骨质疏松性压缩骨折合并椎管狭窄

Posterior Fixation Combined with Percutaneous Vertebroplasty in Treatment of Thoracolumbar Osteoporotic Multilevel Vertebral Compression Fractures with Spinal Stenosis

目的探讨后路椎弓根螺钉内固定术结合经皮椎体成形术治疗多节段胸腰椎骨质疏松性椎体压缩骨折合并椎管狭窄的疗效及可行性。方法选择2008年3月至2010年5月行后路内固定术结合经皮椎体成形术治疗骨质疏松性椎体压缩骨折合并椎管狭窄的16例患者,平均年龄64.3岁。记录术前及术后伤椎前后缘高度,脊柱后凸Cobb角。结果所有患者均手术顺利,伤椎椎体注入骨水泥2.5～6.5ml,平均4.5ml。术中骨水泥向椎间隙渗漏1例,椎旁渗漏6例,但患者术后均无神经压迫症状。所有患者分别在术后1个月～2年进行随访,平均6.2个月。通过影像学测量患者伤椎高度和脊柱后凸Cobb角,术后较术前有明显改善,差异有统计学意义(P<0.05)。结论后路椎弓根螺钉内固定结合经皮椎体成形术治疗多节段胸腰椎骨质疏松性压缩骨折合并椎管狭窄,临床效果满意,有效预防了患者术后腰背部疼痛、活动障碍和后凸畸形等并发症。

Objective To explore the curative effect and feasibility of posterior pedicle screw fixation combined with percutanous vertebroplasty for the treatment of thoracolumbar osteoporotic multilevel vertebral compression fractures with spinal stenosis.Method Research from March 2008 to May 2010 posterior fixation combined with percutaneous vertebroplasty treatment of osteoporotic multilevel vertebral compression fracture with spinal canal stenosis in 16 patients,average age 64.3 years.Recorded the edge around of vertebral height and the kyphosis Cobb＇s angle before and after surgery.Results All cases were successful surgery,injecting bone cement of 2.5ml to 6.5ml into the vertebral,an average of 4.5ml.Intraoperative leakage of bone cement to the intervertebral space in 1 case,6 cases of paravertebral leakage,but the patients had no obvious neurological symptoms.All patients were followed-up an average of 6.2 months.Measured by imaging in patients with vertebral height,kyphosis Cobb angle,after a significant improvement compared with the preoperative,the difference was statistically significant（P0.05）.Conclusion Posterior pedicle screw fixation combined with percutanous vertebroplasty for the treatment of thoracolumbar osteoporotic multilevel vertebral compression fractures with spinal stenosis,which is effective in preventing the postoperative low back pain,obstacles and complications such as kyphosis,and the clinical results are satisfactory.