经皮椎弓根螺钉内固定联合椎体成形术治疗高龄胸腰椎压缩骨折的临床观察

Percutaneous pedicle screw fixation combined with vertebroplasty or kyphoplasty in the surgical treatment of thoracolumbar osteoporosis fracture of aged patients

目的 评估经皮椎弓根螺钉内固定联合椎体成形术治疗高龄骨质疏松性胸腰椎压缩骨折的临床疗效.方法 201 1年2月至2012年10月,使用经皮椎弓根螺钉内固定联合椎体成形术治疗23例无神经功能损伤的高龄骨质疏松性胸腰椎压缩骨折.术前、术后1d、术后3 m、术后6 m、术后12 m和术后18 m分别对患者进行VAS疼痛评分,通过测量CT矢状位图像获得骨折椎体前缘、中间的椎体高度,并测量伤椎局部矢状位Cobb角.结果 所有患者获得随访,随访时间18～36 m（平均22 m）.患者术后第1天VAS评分和末次随访VAS评分较术前均有明显下降（P＜0.05）.术后第1天伤椎前缘和中间的高度较术前明显增大（P＜0.05）,矢状位Cobb角则由术前（16.5±4.7）°显著下降至（5.7±3.2）°（P＜0.05）.术后随访过程中,给予康复训练指导,发现椎体前缘和中间高度以及Cobb角均无明显变化（P＞0.05）.随访过程中,未发现压缩椎体以及相邻椎体新发骨折出现.结论 经皮椎弓根螺钉内固定联合椎体成形术治疗老年骨质疏松性胸腰椎压缩骨折效果满意,可以防止椎体高度再次丢失和相邻椎体新发压缩性骨折.

Objective To evaluate the therapeutic effect of percutaneous pedicle screw fixation combined with vertebroplasty （PVP） or kyphoplasty （PKP） in the surgical treatment of thoracolumbar osteoporosis vertebral compression fracture （VCF） of aged patients. Methods From February 2011 to October 2012, 23 aged patients suffering from fresh thoracolumbar VCF without neurological deficits underwent percutaneous pedicle screw fixation combined with PVP or PKP. Visual analog scale （VAS） pain scores were recorded. And the anterior and central vertebral body heights were measured on the sagittal CT image before operation, 1 day, 3months, 6months, 12months and 18 months after operation. Results All patients were followed up for 18-36 months with a mean of 22 months. VAS scores at 1 day after operation and the end of follow-up were all decreased significantly than that before operation （P〈 0.05）. Both anterior and central vertebral body heights at 1 day after operation increased obviously than those before operation （P〈0.05）. And the Cobb angle was found to be decreased from （16.5±4.7）°before operation to （5.7±3.2）° after operation （P〈0.05）. There were no significant changes in the results obtained over the follow-up period and there was no occurrence of new fracture in surgically treated or adjacent vertebrae in these patients. Conclusion It is satisfactory that percutaneous pedicle screw fixation combined with PVP or PKP in the surgical treatment of thoracolumbar osteoporosis VCF of aged patients. It may prevent the loss of recovered vertebral height and the occurrence of new VCFs after PVP.