椎弓根螺钉内固定联合椎体成形修复单节段胸腰椎骨质疏松性爆裂性骨折

Pedicle screw fixation combined with vertebroplasty for single-level thoracolumbar osteoporotic burst fractures

背景:对于椎管内有骨块占位的骨质疏松性胸腰椎爆裂性骨折,单纯椎体成形术难以解除椎管内占位及纠正脊柱后凸畸形,且骨水泥渗漏发生率高,使其成为其应用的相对禁忌证,而传统椎弓根螺钉系统固定存在手术创伤大、螺钉松动及椎体高度丢失等问题。目的:观察经肌间隙入路短节段椎弓根螺钉内固定联合椎体成形治疗单节段胸腰椎骨质疏松性爆裂性骨折的疗效。方法:回顾分析经肌间隙入路短节段椎弓根螺钉内固定联合椎体成形治疗单节段胸腰椎骨质疏松性爆裂性骨折患者31例。内固定后通过疼痛目测类比评分评估腰背部疼痛情况、ODI评分评估腰背部功能情况、SF-36健康调查评分表评估生活质量、胸腰椎正侧位片评估伤椎椎体前缘高度比值、伤椎Cobb角改善情况、Frankel评分评估神经功能情况及并发症。结果与结论:内固定置入过程均顺利完成,未发生脊髓神经损伤。所有患者随访12-36个月,平均24.5个月,伤椎均达满意复位,平均伤椎椎体前缘高度及Cobb角得到明显改善,腰背部疼痛明显缓解,腰背部功能明显改善,生活质量明显提高,以上所有指标治疗后均显著改善,与治疗前比较差异有显著性意义(P<0.05),内固定后1周和内固定后1年比较差异无显著性意义(P>0.05)。内固定后2例患者出现骨水泥渗漏,其中椎体前缘及椎间隙处少量骨水泥渗漏各1例,但均无临床症状。随访期间,无内固定松动、断裂等,无新发骨折。说明联合应用后路经肌间隙入路短节段椎弓根螺钉内固定及伤椎椎体成形,不仅能有效恢复并维持伤椎椎体高度及强度,重建脊柱稳定性,明显缓解腰背部疼痛,还可以使患者获得满意的腰背部功能,显著提高生存质量,是治疗伴椎管内占位的骨质疏松性胸腰椎爆裂性骨折的有效方法。

BACKGROUND：Vertebroplasty alone cannot relief spinal canal encroachment and kyphosis malformation for treatment of osteoporotic thoracolumbar fractures. Moreover, the occurrence rate of bone cement leakage is high, which becomes a contraindication for its application. Pedicle screw internal fixation alone may increase the trauma, screw loosening and high incidence of late kyphosis deformity. OBJECTIVE：To observe the therapeutic effects of short-segment pedicle screw fixation through paraspinal approach combined with vertebroplasty for single-level thoracolumbar osteoporotic burst fractures. METHODS：A retrospective study was conducted in 31 cases receiving short-segment pedicle screw fixation through paraspinal approach combined with vertebroplasty for single-level thoracolumbar osteoporotic burst fractures. After fixation, clinical outcomes were evaluated mainly with use of visual analog scale for lower back pain. Functions of lower back pain were assessed using Oswestry Disability Index questionnaire. Quality of life＆amp;nbsp;was evaluated using 36-Item Short Form Health Survey. Thoracolumbar anteroposterior and lateral radiographs were utilized to assess anterior vertebral height ratio and the improvement of Cobb angle. Frankel score was applied to evaluate neurological function and complications. RESULTS AND CONCLUSION：Al operations were successful y completed with no spinal cord or nerve damage. Al patients were fol owed up for a mean 24.5 months （12-36 months）. Fractured vertebrae reached satisfactory reduction. The average vertebral body height and Cobb angle significantly improved. The low back pain relieved. Low back function and quality of life improved significantly. Al of the above indicators significantly improved （P〈0.05）. No significant differences were detected between 1-week postoperation and 1-year postoperation （P〉0.05）. After fixation, two patients affected bone cement leakage, including one in anterior vertebral body and one in intervertebral space. However, they did not have clinical symptoms. During fol ow-up, no loosening or breakage, no new fractures occurred. These results indicated that the combination of this technique with vertebroplasty plus internal fixation through paraspinal approach not only restored and maintained vertebral height and strength, reconstructed spinal stabilization, obviously lessened low back pain, but also could make patients get satisfactory low back function and improved the quality of life. It is an effective method for osteoporotic thoracolumbar fractures with spinal canal encroachment.