短节段固定融合结合人工骨椎体增强术治疗骨质疏松性胸腰椎骨折

Short-segment posterior instrumentation and fusion combined with vertebral augmentation for osteoporotic thoracolumbar fractures

目的探讨短节段固定融合结合人工骨椎体增强术治疗骨质疏松性胸腰椎骨折的疗效。方法 31例骨质疏松性胸腰椎骨折采用短节段固定融合结合人工骨椎体增强术治疗,术后获完整随访,从椎体高度丢失率、后凸Cobb's角等情况观察手术效果,腰背痛采用视觉模拟(VAS)疼痛评分评价。结果术前与术后椎体前缘、中央高度丢失率、Cobb’s角相比存在统计学差异(P<0.05),末次随访时椎体前缘、中央、后缘高度丢失率、Cobb’s角与术后相比无显著差异(P>0.05)。VAS评分由术前(8.2±1.3)分降至末次随访(2.3±1.0)分(P<0.05)。结论短节段固定融合结合人工骨椎体增强术可重建伤椎前中柱的稳定性,有效防止椎体高度丢失,是治疗骨质疏松性胸腰椎骨折一种可行的方法。

Objective To investigate the efficacy of short - segment posterior instrumentation and fusion combined with vertebral augmentation for treatment of osteoporotic thoracolumbar fractures. Methods Totally 31 patients with osteoporotic thoracolumbar fractures who underwent vertebral augmentation combined with short - segment posterior instrumentation and postero-lateral fusion were retrospectively reviewed. All patients were followed up. The evaluation strategies including loss rates of vertebral height, kyphotic Cobb＇ s angle and VAS scored system were retrospectively analyzed. Results There were significant differences in loss rates of anterior and mid vertebral height and Cobb angle between postoperative and preoperative radiological measurements. No significant differences were observed in loss rates of vertebral height and Cobb angle between final follow-up and immediately after operation. The mean VAS at final follow-up （ 8.2± 1.3 ） was significantly lower than that at preoperatively （ 2, 3 ± 1.0） （P 〈 0.05）. Conclusion Short-segment posterior instrumentation and fusion combined with vertebral augmentation are testified to be efficient for restoring the vertebral mechanical strength and reducing loss of vertebral height, which seems to be a feasible option in the management of osteoporotic thoracolumbar fractures.