后路截骨联合钉道强化术治疗陈旧性骨质疏松性胸腰椎骨折并后凸畸形

Posterior transpedicular osteotomy with Polymethylmethacrylate-augmented pedicle screw instrumentation for obsolete osteoporotic thoracolumbar fractures with kyphosis deformity

目的观察后路截骨联合钉道强化术治疗陈旧性骨质疏松性胸腰椎骨折并后凸畸形的临床效疗。方法回顾性分析2008年1月～2010年6月采用此方法治疗的21例陈旧性骨质疏松性胸腰椎骨折并后凸畸形患者的临床资料,应用Oswestry功能障碍指数(Oswestry Disability Index,ODI)、疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国脊髓损伤学会(American spinal injury association,ASIA)分级、影像学资料评估治疗效果,并记录手术并发症。结果所有患者随访16～24个月,平均随访18.7月。术后3个月及末次随访时VAS评分、ODI评分、Cobb角与术前相比差异均有统计学意义(P<0.05)。所有患者均未发生内固定相关并发症,没有出现有症状的骨水泥渗漏。末次随访时21例患者中ASIA分级C级恢复到D级1例、恢复到E级1例,由D级恢复到E级19例。结论后路截骨联合钉道强化术治疗陈旧性骨质疏松性胸腰椎骨折并后凸畸形短期疗效满意。

Objective To observe the clinical efficacy of posterior transpedicular osteotomy with Polymethylmethacrylateaug mented （PMMA） pedicle screw instrumentation for obsolete osteoporotie thoracolumbar fractures with kyphosis deformity. Methods From January. 2008 to June 2010, 21 patients of obsolete osteoporotic thoracolumbar fractures with kyphosis deformity were included in the study. The patients were treated with lumbar spinal decompression, osteotomy and pedicle screw instrumentation by augmenta tion with PMMA. The postoperative outcomes were evaluated using Oswestry disability index （ODI） , visual analog scale （VAS） score, American Spinal Injury Association （ASIA） classification and radiological findings, and recorded the operative complica tions. Results All cases were followed up for 1624 months （18.7 months in average）. There is significant difference between postoperative 3 months , final followup and preoperative in VAS score, ODI, and Cobb＇ s angle （P 〈 0. 05）. There were no compli cation related to the internal fixation failure occurred, and no symptomatic PMMA leakage. At final followup, The neurological function were improved from C to D 1 case, from D to E 1 case, from D to E 19 case. Conclusion For obsolete osteoporotic thora columbar fractures with kyphosis deformity patients, posterior transpedicular osteotomy with Polymethylmethacrylateaugmented pedi cle screw instrumentation is effective and satisfying during shortterm followup.