后路椎弓根钉棒系统联合椎体支柱块治疗老年陈旧性骨质疏松性脊柱压缩骨折

Treatment of old people's old osteoporotic spinal compression fractures by posterior pedicle screw system combined with vertebral spacer

目的探讨后路椎弓根钉棒系统联合椎体支柱块治疗老年陈旧性骨质疏松性脊柱压缩骨折的临床疗效。方法 2009年7月—2011年1月我科收治老年陈旧性(病程>3月)骨质疏松性脊柱压缩骨折患者10例,采用脊柱后路正中切口,应用椎弓根钉棒系统对伤椎复位、内固定并经伤椎椎弓根双侧置入椎体支柱块治疗,观察术后疼痛、伤椎高度及Cobbs角的变化情况。结果患者术后平均7 d下床活动,术后疼痛明显缓解(VAS评分改善),未出现操作引起的血管神经损伤并发症,伤椎高度恢复良好,Cobbs角较术前明显减少,后突畸形得到明显纠正,住院平均时间12.5 d。经过6～18个月随访,远期疼痛无复发,伤椎高度无丢失,Cobbs角无改变,未见内置物松动、断裂。结论后路椎弓根钉棒系统联合椎体支柱块治疗老年陈旧性骨质疏松性脊柱压缩骨折在后路手术不加大创伤的同时,具有操作简单,能显著恢复伤椎椎体高度及增加椎体前中柱的抗压稳定性,使病人能早期下床活动,止痛效果好,纠正脊柱后凸畸形,远期能有效防止术后骨质疏松引起椎体再塌陷及内置物松动、断裂的发生。远期疗效好,且手术并发症少,相对安全可靠,获得满意疗效。

Objective To explore clinical therapeutic effects of posterior pedicle screw system combined with vertebral spacer in treating old people＇s old osteoporotic spinal compression fractures. Methods Our department received and treated 10 patients suffering from old osteoporotic spinal compression fractures（duration3 months） from July 2009 to January 2011.After posterior median incision of spine,pedicle screw system was applied to have the injured vertebra restored and internally fixated.Furthermore,it was placed through both sides of pedicle screw of injured vertebra into the vertebral spacer for treatment to observe the changes in postoperative pains,height of injured vertebra and Cobb angle. Results Patients got out of bed and walked around every seven days after operation.After operation,their pains were obviously relieved（improvement in VAS scores） and no complications such as vascular and nerve injuries were caused by operation.Besides,the height of injured vertebra was well recovered and there was an eminent decline in Cobb angles.Kyphotic deformities were significantly corrected and the hospitalization duration was 12.5 days on average.After 6 to 18 months of follow-up visits,it was found that patients＇ chronic pains didn＇t recur,there was no decrease in the height of injured vertebra,no changes occurred to Cobb angles and no internal fixation devices got loose or broken. Conclusion The posterior pedicle screw system combined with vertebral spacer won＇t make the trauma get worse during its treatment of old people＇s osteoporotic spinal compression fractures through posterior operation.Being easily operated,it can significantly recover the height of injured vertebra and enhance the stability of anterior,middle and posterior columns against high pressure,in order that patients can get out of bed and walk around earlier.Additionally,it is effective in relieving pain and correcting kyphotic deformities.Meanwhile,it can effectively protect the vertebra from collapsing again and internal fixation devices from getting loose or broken in a long term.This system is safe and reliable,by which satisfactory long-term therapeutic effects can be achieved with few complications.