体外整复与个体化后凸成形术治疗骨质疏松胸腰椎骨折后凸伴侧凸畸形的疗效

The effect of extracorporeal reorganization and individual kyphoplasty in the treatment of kyphosis and scoliosis after osteoporotic thoracolumbar fractures

目的评估老年性骨质疏松胸腰推压缩骨折后凸伴侧凸畸形采用术前垫枕复位,术中过伸、侧屈位整复,依据骨折特点个体化椎体后凸成形术治行的临床效果和安全性。方法选择12例13椎老年骨质疏松性胸腊椎压缩骨祈后凸伴侧凸畸形患者,术前CT或X线片证实椎体前方伴侧方压缩,MR提示推体新鲜骨折,采用术前垫枕复位、术中透视下过伸侧屈位整复,根据复位椎体的形态进行个体化椎体后凸成形,由脊柱侧凸崎形的凹侧椎弓根进针穿刺球囊扩张后凸成形术。比较术前、术后伤椎高度和脊柱崎形Cobb's角,日常生活恢复程度采用Owestry功能障碍指数(Owestry Disability Inckx,OD1)评估,采用视觉模拟评分法(visual analogue scale,VAS)进行手术前、后疼痛比较。结果 12例患者均顺利完成手术,术后脊柱后凸及侧凸崎形Cobb's角、伤椎前绿、中部、侧方高度与术前比较,伤椎复位明显、差异有统计学意义(P<0.05);术后与术前患者疼痛VAS评分比较、疼痛缓解明显、差异有统计学意义(P<0.05)。患者均可在术后次日行走,ODI评分术后与术前相比明显降低,差异有统计学意义(P<0.05)。未发现神经损伤等手术并发症。结论对于老年骨质疏松性胸腰椎骨折后凸伴侧凸畸形,根据充分体外整复后的伤椎形态行个体化椎体后凸成形术治疗能够取得良好疗效。

Objective To evaluate the clinical efficacy and safety of preoperative cushion pillow reduction, intraopera- tire over-extension, lateral flexion and rectification and individual kyphoplasty based on the fracture characteristics in treatment of kyphosis and scoliosis after osteoporotic thoracolumbar compression fractures in the aged patients. Methods A total of 12 cases of kyphosis and scoliosis after elderly osteoporotic thoracolumbar fractures of 13 vertebrae were en- rolled. Vertebral body anterior and lateral compression was confirmed by preoperative CT or X-ray, and fresh vertebral fracture was prompt by MR. Preoperative cushion pillow reduction, intraoperative over-extension, lateral flexion and rectification were used. Individualized vertebral kyphoplasty was performed according to the morphology of the reset vertebral body. Puncture balloon kyphoplasty was operated by puncturing on concave side of the pedicle in scoliosis. Preoperative and postoperative kyphosis and scoliosis Cobb^s angle were compared. The degree of daily life recovery was evaluated by Owestwest Disability Index （ODI）. Visual analogue scale （VAS） was used for preoperative and postop- erative pain comparison. Results The 12 patients all completed the operation successfully. There were significant differ- ences in postoperative kyphosis and scoliosis Cobb＇s angle, disease front, middle and lateral height before and after op- eration（P〈0.05）. Preoperative and postoperative pain VAS scores were compared, and there was significant difference in pain relief （P〈0.05）. Patients could walk on the postoperative day, ODI score of postoperative was significantly lower than that of the preoperative and difference was statistically significant （P〈0.05）. There were no surgical complications such as nerve damage. Conclusion For kyphosis and scoliosis after osteoporotic thoracolumbar fractures of the elderly, the individualized kyphoplasty treatment should be based on vertebral morphology after full manipulative restoration, which can achieve good results.