经皮强化椎弓钉联合后凸成形术治疗重度骨质疏松胸腰椎骨折

Percutaneous cement-augmented pedicle screw fixation combined with kyphoplasty for severe osteoporotic thoracolumbar fractures

[目的]观察经皮强化椎弓根联合经皮椎体后凸成形术(percutaneous kyphoplasty, PKP)治疗重度骨质疏松性胸腰椎压缩骨折(osteoporotic vertebral compression fractures, OVCF)的疗效。[方法]回顾性分析行经皮强化椎弓根联合PKP治疗的72例老年重度OVCF患者。总结围手术期、随访与影像资料。[结果] 72例患者均顺利完成手术,无严重并发症。随时间推移腰痛VAS评分、下肢痛VAS评分和ODI均显著降低(P<0.05)。随访过程中,9例(12.50%)新发骨折,再次接受PKP治疗后症状缓解。影像方面,与术前相比,术后后凸Cobb角显著减少(P<0.05),而伤椎前缘高度比和伤椎矢状面指数均显著增加(P<0.05)。术后各时间点间比较,上述指标均无显著改变(P>0.05)。[结论]钉道强化经皮后路椎弓根内固定联合PKP治疗老年重度OVCF安全有效,可有效重建伤椎高度及矫正后凸畸形。

[Objective] To evaluate the clinical outcomes of percutaneous cement-augmented pedicle screw fixation combined with percutaneous kyphoplasty(PKP) in the treatment of severe thoracolumbar osteoporotic vertebral compression fractures(OVCF). [Methods] A retrospective study was done on 72 elderly patients who received percutaneous cement-augmented pedicle screw fixation combined with PKP for severe OVCF. The documents of the perioperative period, follow-up and radiographs were summarized. [Results] All the 72 patients had operation completed successfully without serious complications. The VAS scores of low back pain and lower limb pain, as well as ODI score significantly reduced over time(P<0.05). During the follow-up, 9 patients(12.50%) had new fractures, which were resolved after PKP again. In terms of imaging assessment, the kyphotic Cobb angle significantly reduced(P<0.05), while the anterior edge height ratio and SI of the injured vertebrae significantly increased postoperatively compared with those preoperatively(P<0.05). However, there were no significant changes in the above indexes compared among time points after operation(P>0.05). [Conclusion] The percutaneous cementaugmented pedicle screw fixation combined with PKP is safe and effective treatment of severe OVCF in the elderly, and does effectively reconstruct the height of the injured vertebrae and correct the kyphotic deformity.