Genex骨水泥结合短节段椎弓根内固定治疗骨质疏松性骨折伴真空征

The Genex Cement Combined with Short Segment Transpedicular Fixation in Treatment of Osteoporosis Vertebral Compression Fracture with Vacuum Phenomenon

目的评估Genex骨水泥椎体成形术结合短节段椎弓根内固定治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)伴椎体真空征的疗效。方法 2008年3月至2010年7月,采用Gennex骨水泥椎体成形术结合短节段椎弓根内固定治疗23例OVCF伴椎体真空征患者,其中18例获得随访,男7例,女11例;年龄57～71岁,平均64岁。病程3～14个月,平均8.4个月。根据Kraus5,标准均诊断为椎体真空征。术后定期随访,通过侧位X线片测量伤椎的前、中、后缘高度和局部后凸角,采用SF-36健康调查评分表评估患者术后生活质量的改善。结果所有患者均顺利完成手术,无严重并发症发生。18例术后随访时间9～38个月,平均18个月。Genex骨水泥术后3个月开始吸收,6个月时候完全吸收。椎体骨折愈合时间为4～6个月,平均4.5个月。伤椎前缘、中部高度较术前明显恢复,差异有统计学意义(P<0.05),后缘高度手术前后各时间点差异均无统计学意义(P>0.05)。末次随访时椎体高度维持良好(P>0.05)。术后SF-36评分表8个分项维度中有7个显著提高,与术前相比,差异有统计学意义(P<0.05),末次随访时7个分项维度均得到较好的维持,和术后相比差异无统计学意义(P>0.05)。术后1周CT复查发现2例发生骨水泥椎间隙渗漏,但均术无临床症状。结论 Genex骨水泥椎体成形术结合短节段椎弓根内固定治疗骨质疏松性椎体压缩骨折伴椎体真空征,术后可即可缓解疼痛,恢复椎体高度,减小后凸畸形,恢复脊柱矢状序列,提高患者的生活质量,并且在椎体骨折愈合后Genex骨水泥在体内完全降解。

Objective To evaluate the clinic efficacy of genex cement augmentation combined with short segment transpedcular fixation in treatment of osteoporosis vertebral compression fracture （OVCF） with vacuum phe-nomenon. Methods From march 2008 to July 2010,23 patients of OVCF with vacuum phenomenon were treated by genex cement augmentation combined with short segment transpedcular fixation. 18 patients （7 male 11 female） with an average age of 64 years （from 57 to 71） were diagnosed as OVCF with vacuum phenomenon. They had experienced duration from 3 months to 14 months （mean 8.4 months）. The operation restored vertebral height and the decreased kyphosis angle according to the X-ray before and after operation. The quality of life were evaluated by SF-360 before and after operation. Results All patients were underwent the surgical procedure successfully without severe compli-cation. The genex cement gradually absorbed at 3 months after operation and fully absorbed at 6 months after opera- tion. The healing time of the fractured vertebrae with an average time of 4.5 months （from 4 months to 6 months）. There were significant difference of anterior and medium height of vertebrae between before and after operation（P〈 0.05）. The kyphosis angles were reduced significantly after operation （P〈0.05）. 7 of 8 subscales of SF 360 were im-proved significantly after operation （P〈0.05） and this improvement was sustained up to the last follow up. The ce ment leakage in 2 patients without symptom were found by CT examination after 1 week. Conclusion The vertebral height and kyphotic angles and life quality of all patient were improved significantly after operation. The genex cement was fully absorbed when the fractured healed.