骨质疏松性椎体压缩骨折合并椎管狭窄症的治疗

Limited laminectomy decompression combined with vertebroplasty for management of ostoporotic vertebral fractures with spinal stenosis

目的观察椎板有限切除减压与椎体成形术相结合治疗骨质疏松性椎体压缩骨折合并椎管狭窄症的疗效。方法合并椎管狭窄、脊髓或硬膜囊、神经根受压的骨质疏松性椎体压缩骨折患者10例,在椎体成形术之前,先采用小切口行狭窄节段椎板有限切除,显露硬膜囊及神经根,打压复位或切除椎体后方突出的骨块,解除脊髓及神经根的压迫,然后直视下经椎弓根穿刺,完成椎体成形操作。结果手术时间80～120 min,操作顺利,无骨水泥向椎管内渗漏。腰背部疼痛缓解,神经受压及椎管狭窄症状消失。结论该方式结合了椎板切除减压和椎体成形两种手术的优点,在减压后完成椎体成形,既可有效解除压迫症状,又可及时探查椎管,处理可能发生的骨水泥向椎管内渗漏等并发症。该技术是治疗伴有椎管狭窄症状的严重的椎体压缩性骨折的有效方法。

Objective To observe the therapeutic effect of percutaneous vertebroplasty（PVP） combined with limited laminectomy decompression in the treatment of complicated osteoporotic vertebral fractures.Methods Before the vertebroplasty was preformed,limited laminectomy decompression was performed to reduce the fragmentation of the posterior wall in 10 patients with osteoporotic fractures involving neural compression.Results About 80-120 minuts was taken to perform the vertebroplasty and limited laminectomy decompression.There were no complications happened in all patients.The fragmentation of the posterior wall was pushed award easily.No cement leakage was found.The patients could walk freely and the neurological deficits were improved completely at postoperation.Conclusion Vertebroplasty combined with limited laminectomy decompression makes the treatment of severe osteoporotic fractures involving fragmentation of the posterior wall and neural compromise safe and effective.Decompression of spinal stenosis is of effective therapy and the risk of epidural cement leakage can be controlled intraoperatively.