脊柱外固定装置牵张下经皮椎体成形治疗后壁破损椎体骨质疏松压缩骨折

Percutaneous vertebroplasty under distraction with external spinal fixator for vertebral osteoporotic compression fractures with posterior wall damage

背景:对于后壁破损椎体骨质疏松压缩骨折伴椎管占位,国内外多采用开放手术或保守治疗。老龄骨质疏松患者用脊柱外固定装置轴向牵张前后纵韧带,使椎管占位后移骨块复位,同时扩大椎管,然后行经皮椎体成形术固化椎体,在临床中取得良好的治疗效果。目的:观察后壁破损椎体骨质疏松压缩骨折伴椎管占位患者前后纵韧带在脊柱外固定装置牵张下行经皮椎体成形的临床疗效。方法:选取老年后壁破损椎体骨质疏松压缩骨折伴椎管占位患者52例,年龄61-86岁,平均(78.62±5.20)岁;采用脊柱外固定联合经皮椎体成形术治疗,治疗前、治疗后1 d、治疗后3个月及末次随访(术后12个月)时,用X射线片及CT观察椎体前缘高度丢失率、后凸成角、椎管狭窄率及骨折椎体内骨水泥分布范围,同时进行目测类比评分、Oswestry功能障碍指数评估。结果与结论:52例患者随访3-12个月。X射线片示治疗前、治疗后1d、治疗后3个月、末次随访时的椎体前缘高度丢失率分别为(34.5±2.2)%,(3.5±1.3)%,(4.0±0.6)%,(4.4±1.1)%,后凸成角分别为(12.1±1.7)°,(4.0±0.8)°,(3.5±0.5)°,(4.4±0.2)°,CT示椎管狭窄率分别为(40.9±7.2)%,(10.7±2.5)%,(9.7±1.1)%,(9.8±0.7)%;骨折椎体骨水泥填充分布范围均≥75%;治疗前与治疗后1 d目测类比评分、Oswestry功能障碍指数比较差异有显著性意义(P<0.05),治疗后3个月与末次随访时目测类比评分、Oswestry功能障碍指数比较差异无显著性意义(P>0.05)。结果表明,椎体前后纵韧带牵张下经皮椎体成形治疗不仅显著改善后壁破损椎体骨质疏松压缩骨折伴椎管占位复位的临床效果,还能提高椎体固化率,减轻疼痛,是一种安全有效的微创组合新技术。

BACKGROUND:Posterior wall damaged vertebral osteoporotic compression fracture with spinal canal occupying is often treated by open surgery or conservative therapy at home and abroad.For elderly patients with osteoporosis,with the external spinal fixation device,the axial distraction of the spinal canal occupying the posterior bone block reduction,expansion of the spinal canal,and percutaneous vertebroplasty to solidify the vertebral body achieved good clinical results.OBJECTIVE:To observe the clinical effect of percutaneous vertebroplasty of anterior and posterior longitudinal ligaments for osteoporotic compression fracture of vertebral body with posterior wall damage under external spinal fixation.METHODS:A total of 52 aged patients with osteoporotic compression fracture of vertebral body with posterior wall damage were selected,aged from 61 to 86 years(mean 78.62±5.20 years).The patients were treated with external spinal fixation combined with percutaneous vertebroplasty.X-ray and CT were used to observe the anterior margin height loss,kyphosis angulation,vertebral stenosis,and bone cement distribution in the fractured vertebrae before,1 day and 3 months postoperatively,during final follow-up(12 months postoperatively).Visual analogue scale score and Oswestry dysfunction index were also evaluated.RESULTS AND CONCLUSION:Fifty-two cases were followed up for 3-12 months.X-ray films exhibited that preoperatively and 1 day,3 months postoperatively,at final follow-up,the loss rates of anterior vertebral body height were(34.5±2.2)%,(3.5±1.3)%,(4.0±0.6)%,and(4.4±1.1)%;the kyphosis angles were(12.1±1.7)°,(4.0±0.8)°,(3.5±0.5)°,and(4.4±0.2)°.CT showed that the spinal stenosis rates were(40.9±7.2)%,(10.7±2.5)%,(9.7±1.1)%,and(9.8±0.7)%.The distribution range of bone cement filling in fractured vertebral bodies was all≥75%.There were significant differences in visual analogue scale score and Oswestry disability index before and 1 day after treatment(P<0.05).There was no significant difference in visual analogue scale score and Oswestry disability index between 3 months after surgery and last follow-up(P>0.05).The results have shown that percutaneous vertebroplasty under anterior posterior longitudinal ligament stretch of the vertebral body not only significantly improves the clinical effect of osteoporotic vertebral compression fracture repair,but also improves the vertebral body solidification rate and relieves pain,which is a safe and effective minimally invasive combination of new technology.