椎弓根螺钉结合椎体成形术治疗椎管狭窄症伴老年性骨质疏松性压缩骨折

Pedicle screws combined with vertebroplasty for lumbar spinal stenosis complicated with osteoporotic vertebral compression fracture

目的探讨椎弓根螺钉结合椎体成形术治疗椎管狭窄症伴狭窄节段骨质疏松性压缩骨折疗效。方法 2009年1月至2014年5月,我院收治椎管狭窄症伴狭窄节段老年性骨质疏松性压缩骨折患者15例,其中男9例,女6例。年龄58~81岁,平均(69.9±7.26)岁。所有患者在压缩性骨折椎体经椎弓根注入骨水泥,行椎弓根螺钉强化,其它减压范围的椎体直接拧入椎弓根螺钉,后行椎管减压。评价术前1天、术后1周及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(oswestry disability index,ODI)评分,评估患者腰痛、下肢痛及生活质量改善情况;对比病椎后凸畸形角度(Cobb’s角)和骨折椎体高度恢复情况。结果所有患者均顺利完成手术,置入螺钉过程中发生骨水泥渗漏4例,无放热效应及毒性反应引起的并发症;术后腰痛及下肢痛明显缓解,腰痛VAS评分由术前(8.43±1.34)分下降至术后1周(3.21±0.91)分,末次随访时为(2.36±0.79)分;腿痛VAS评分由术前(7.53±1.72)分下降至术后1周(2.64±0.85)分,末次随访时为(1.84±0.60)分;ODI评分由术前(58.63±4.53)分下降至术后1周(28.40±2.45)分,末次随访时为(26.40±2.14)分。腰、腿痛VAS评分、ODI评分术后与术前比较差异均有统计学意义(P<0.05)。Cobb’s角变化、椎体高度变化术后与术前比较差异无统计学意义(P>0.05)。15例获得12~36个月随访,平均(22.4±8.5)个月,随访中无椎弓根螺钉松动、断裂或拔出,无相邻椎体的压缩骨折,螺钉周围未见透亮线的出现。结论骨折椎体注入骨水泥并椎弓根螺钉锚定的椎管扩大减压内固定术治疗椎管狭窄症伴狭窄节段骨质疏松性压缩骨折效果良好,能有效地缓解腰背部疼痛,改善患者功能,提高生活质量。

Objective To explore the curative outcomes of pedicle screws combined with vertebroplasty in the treatment of lumbar spinal stenosis（ LSS） complicated with osteoporotic vertebral compression fracture（ OVCF）. Methods From January 2009 to May 2014, 15 patients（ 9 men and 6 women） with LSS complicated with OVCF were treated in our hospital, with an average age of（ 69.9 ± 7.26） years（ range： 58-81 years）. Bone cement augmentation of the screw channel was conducted in the vertebra of compression fracture, and then the pedicle screws were inserted in the segments of canal stenosis including the cement augmented vertebra, followed with lumbar canal decompression. The visual analogue scale（ VAS） and Oswestry disability index（ ODI） were applied to analyze the improvement of the lumbar and leg pain and life quality at 1 day before surgery, at 1 week after surgery and at the latest follow-up. Improvement of kyphotic angle（ Cobb＇s angle） and restoration of anterior vertebral body height were also compared at 1 day before surgery, at 1 week after surgery and at the latest follow-up. Results The surgery was successfully performed in all the patients. Complications due to heat-induced effects and toxicity in the screw implantation process did not occur. Four patients had bone cement leakage. There was a significant improvement in the lumbar and leg pain after surgery. The lumbar pain VAS was decreased from（ 8.43 ± 1.34） before surgery to（ 3.21 ± 0.91） at 1 week after surgery and（ 2.36 ± 0.79） at the latest follow-up, and the leg pain VAS was decreased from（ 7.53 ± 1.72） before surgery to（ 2.64 ± 0.85） at 1 week after surgery and（ 1.84 ± 0.60） at the latest follow-up. There was a significant decrease in the ODI from（ 58.63 ± 4.53） before surgery to（ 28.40 ± 2.45） at 1 week after surgery and（ 26.40 ± 2.14） at the latest follow-up. Statistically significant differences were noticed in the lumbar and leg VAS and ODI scores before and after surgery（ P〈0.05）. But the differences in the Cobb＇s angle and restoration of vertebral body height weren＇t statistically significant before and after surgery（ P〈0.05）. All the 15 patients were followed up and the average follow-up time was（ 22.4 ± 8.5） months（ range： 12-36 months）. There was no loosening, fracture or pull-out of the screws, no adjacent vertebral compression fractures, and no radiolucent lines appeared around the screws during the follow-up. Conclusions Bone cement augmentation with the screw conducted in the vertebra of compression fracture, followed with lumbar canal decompression in the treatment of LSS complicated with OVCF can efficiently reduce the pain of lower back and leg, improve the function and improve patients＇ life quality, with satisfactory clinical outcomes.