后路椎体次全切治疗胸腰段椎体成形术椎再骨折的疗效分析

Posterior subtotal vertebrectomy for thoracolumbar vertebral refractures after vertebroplasty

目的探讨经后路椎体次全切治疗胸腰段椎体成形术椎再骨折的疗效。方法回顾性分析2017年6月至2019年10月河南省人民医院脊柱外科收治的28例胸腰段椎体成形术椎再骨折患者资料。男7例,女21例;年龄61~76岁,平均62.4岁;骨折椎体:T115例,T129例,L111例,L23例;既往手术方法:经皮椎体成形术治疗17例,经皮椎体后凸成形术治疗11例。手术方法:后路切除棘突、椎板,经侧方切除关节突、横突,部分切除椎体、骨水泥及上下椎间盘,神经减压,椎体间人工椎体固定,后路钉棒矫形固定。记录手术时间及术中出血量,比较患者术前和末次随访时后凸cobb角评价矫形效果;比较患者术前和末次随访时疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分评价脊柱功能改善情况。结果本组患者手术时间平均为182.1 min,术中出血量平均为996.2 mL。28例患者术后随访8~29个月(平均19.8个月),无明显神经功能损伤及其他严重并发症发生。cobb角由术前的41.3°±10.3°改善为末次随访时的6.4°±2.5°,VAS评分由术前的(7.3±1.8)分改善为末次随访时的(2.5±1.0)分,JOA评分由术前的(8.4±2.3)分改善为末次随访时的(21.3±2.5)分,以上比较差异均有统计学意义(P<0.05)。结论经后路椎体次全切治疗胸腰段椎体成形术椎再骨折,可一期进行骨水泥清除、椎管减压、椎间植骨融合,重建脊柱稳定性,有很好的疗效。

Objective To evaluate the efficacy of posterior subtotal vertebrectomy in the treatment of thoracolumbar vertebral refractures after vertebroplasty.Methods A retrospective analysis was conducted in the 28 patients with refracture after percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)who had been treated at Department of Spinal Surgery,Henan Provincial People's Hospital from June 2017 to October 2019.They were 7 males and 21 females,with an average age of 62.4 years(from 61 to 76 years).A total of 28 vertebrae were involved,including 5 T11s,9 T12s,11 L1s and 3 L2s.Their previous operations were PKP in 17 cases and PVP in 11.After the spinous process,vertebral plate,articular process and transverse process were resected by posterior approach,the vertebral body,bone cement and upper and lower intervertebral discs were partially resected by trans-vertebral lateral approach.At the same time,nerve decompression was performed.Finally,the inter-vertebral support was fixated followed by the posterior screw-rod orthopedic fixation.The operation time and intraoperative bleeding volume were recorded.The cobb angles of kyphosis were compared on the X-ray films of the whole spine between preoperation and the last follow-up to evaluate correction.Functional improvement of the spine was evaluated by comparison of the visual analogue scale(VAS)and JOA(Japanese Orthopedics Association)scores between preoperation and the last follow-up.Results The operation time averaged 182.1 min and intraoperative bleeding volume 996.2 mL.All the 28 patients were followed up for 8 to 29 months(mean,19.8 months).No obvious neurological lesions or other serious complications were observed.The cobb angle was improved from preoperative 41.3°±10.3°to 6.4°±2.5°at the last follow-up,the VAS score from preoperative 7.3±1.8 to 2.5±1.0 at the last follow-up,and the JOA score from preoperative 8.4±2.3 to 21.3±2.5 at the last follow-up,showing a significant difference in all the comparisons(P<0.05).Conclusion The posterior subtotal vertebrectomy is effective for thoracolumbar vertebral refractures after vertebroplasty because it can remove bone cement,decompress the spinal canal,fuse the inter-vertebral graft and reconstruct the spinal stability in one stage.