椎体成形联合椎板有限切除治疗PKP术后椎体再骨折伴椎管狭窄

Vertebroplasty combined with limited laminectomy for vertebral refractures accompanied with lumbar spinal canal stenosis secondary to percutaneous kyphoplasty

[目的]探讨椎体成形联合椎板有限切除治疗PKP术后椎体再骨折伴椎管狭窄的临床疗效。[方法]回顾性研究本院2012年10月~2014年8月收治的骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)经PKP治疗后再发椎体骨折合并椎管狭窄的62例患者资料,其中男27例,女35例,年龄65~86岁,平均(72.46±9.07)岁,采用椎体成形联合椎板有限切除的方法进行手术治疗,并通过VAS疼痛评分、脊柱矢状位后凸Cobb角、伤椎前缘压缩比、脊柱动力位交角变化、JOA评分、腰椎功能改善指数、改善率对患者术前和术后不同时间点随访进行临床疗效评价。[结果]所有患者均顺利再手术,无严重并发症。所有患者随访18个月以上。VAS评分随时间延长显著减低,差异有统计学意义(P<0.05)、JOA评分随时间延长显著增加,差异有统计学意义(P<0.05)。术后Cobb角显著减少,术后不同时间点Cobb角与术前相比,差异均有统计学意义(P<0.05),但术后不同时间点间Cobb角变化差异无统计学意义(P>0.05)。随术后时间延长脊柱动力位交角变化增加,差异有统计学意义(P<0.05)。[结论]椎体成形联合椎板有限切除是治疗PKP术后椎体再骨折伴椎管狭窄的有效手术方法,该治疗方案风险小,术后并发症少。

[Objective] To explore the clinical outcome of vertebroplasty combined with limited laminectomy in the treatment of vertebral refractures accompanied with lumbar spinal canal stenosis secondary to percutaneous kyphoplasty. [Method] A retrospective study was conducted on 62 patients who received vertebroplasty combined with limited laminectomy for vertebral refractures accompanied with lumbar spinal canal stenosis secondary to percutaneous kyphoplasty for the primary osteoporotic vertebral compression fractures （OVCFs） in our hospital from October 2011 to August 2014. Of them, 27 males and 35 females aged ranged from 65 to 86 years old with an average of（72.46±9.07） years. The clinical consequences were assessed using visual analog scale（VAS） of pain on lumbar spine and lower limbs,Japanese Orthopedic Association（JOA） score, as well as radiographic measurements, such as sagittal Cobb angle of vertebrae with osteoporotic compression fractures, the compression ratio of the vertebrae, and angle changes of flexion-extension radiographs. [Results] All the patients had operation performed smoothly without serious complications.All of them were followed up more than 18 months. The VAS significantly declined over time（P〈0.05）, while the JOA scores considerably increased as postoperative time elapsed（P〈0.05）. In term of the radiographic measurements, the sagittal Cobb angle significantly decreased after operation, with statistical differences between the data before operation and those of different time points after operation（P〈0.05）, however, it kept unchanged among the different time points after operation（P〉0.05）. In addition, variations of the angle on dynamic lateral radiographs were remarkably enhanced over time postoperatively（P〈0.05）.[Conclusion] The vertebroplasty combined with limited laminectomy is a reliable treatment for vertebral refracture accompanied with lumbar spinal canal stenosis secondary to previous percutaneous kyphoplasty, with low surgical risks and low complications.