晚期椎体骨坏死两种治疗方法的疗效

Efficacy of two methods in the treatment of advanced vertebral osteonecrosis

目的评价单纯椎体成形术和后路椎弓根螺钉强化撑开复位联合病椎椎体成形术治疗晚期椎体骨坏死的临床疗效。方法根据椎体后壁是否完整,将35例椎体骨坏死患者分为椎体成形手术治疗组(A组,22例)和后路椎弓根螺钉撑开复位联合病椎椎体成形术治疗组(B组,13例)。测量手术前后病椎前缘压缩率,采用疼痛视觉模拟评分(VAS评分)和Oswestry功能障碍指数(ODI)评价手术效果。结果 A组和B组术后1周和2年的病椎前缘压缩率、VAS和ODI评分均较术前降低(P<0.05)。结论对于椎体后壁完整的患者,宜选择椎体成形术;对于椎体压缩严重后壁破裂伴有脊髓压迫的患者,则需要行后路椎弓根螺钉撑开复位联合病椎椎体成形术治疗。

Objective To evaluate the clinical efficacy of treaing advanced vertebral osteonecrosis with vertebroplasty or with strengthened open reduction by posterior pedicle screw combined with vertebroplasty of diseased vertebra.Methods Thirty-five patients with vertebral osteonecrosis were divided into two groups of A（operated by conventional vertebroplasty,22cases）and B（operated by strengthened open reduction by posterior pedicle screw combined with vertebroplasty,13 cases）according to the integrity of posterior wall of vertebral body.The compression rate of anterior vertebra was measured before and after operation,and the surgical outcome was evaluated by VAS pain score and Oswestry disability index（ODI）.Results The compression rate of anterior vertebra,VAS pain scores and ODI on the 1^st week and 2^nd year after operation were lower than those before operation in groups of A and B（P〈0.05）.Conclusion Vertebroplasty is suitable for the patients with an intact posterior wall of vertebral body.The strengthened open reduction by posterior pedicle screw combined with vertebroplasty of diseased vertebra would be better in the patients with severe vertebral rupture of posterior wall with spinal cord compression.