腰椎牵引续贯骨水泥强化治疗重度骨质疏松性椎体压缩骨折合并终板-椎间盘复合体损伤

Lumbar traction followed by bone cement augmentation for treatment of severe osteoporosis vertebral compression fractures combined with endplate-disc complex injury

目的评估腰椎牵引续贯伤椎经皮椎体后凸成形术联合损伤椎间盘及邻近椎体骨水泥强化治疗重度骨质疏松性椎体压缩骨折合并终板-椎间盘复合体损伤的可行性、有效性及安全性。方法回顾性分析自2019-01—2020-12诊治的12例重度骨质疏松性椎体压缩骨折合并终板-椎间盘复合体损伤,首先对患者进行过伸位腰椎牵引,待伤椎椎体高度部分恢复后,将骨折椎体、损伤的终板-椎间盘复合体、邻近椎体组成的脊柱运动单元作为整体进行骨水泥强化。结果12例均获得随访,随访时间平均24.3(14~35)个月,均未出现血管神经损伤、脊柱感染、肺栓塞等并发症。腰椎牵引后患者局部后凸Cobb角较入院时减小,局部后凸Cobb角为18.9°~30.5°,平均26.2°;末次随访时局部后凸Cobb角为15.6°~23.8°,平均19.0°。腰椎牵引后患者伤椎前缘高度增加,椎体前缘高度为18.7~31.4 mm,平均26.8 mm;末次随访时椎体前缘高度为18.4~38.6 mm,平均29.9 mm。腰椎牵引后患者椎间角为2.3°~7.4°,平均5.2°;末次随访时椎间角为2.4°~7.3°,平均5.5°。末次随访时疼痛VAS评分为0~2分,平均0.8分;ODI指数为9%~25%,平均16.3%。结论重度骨质疏松性椎体压缩骨折合并终板-椎间盘复合体损伤采用过伸位腰椎牵引续贯伤椎经皮椎体后凸成形术联合损伤椎间盘及邻近椎体骨水泥强化治疗能够明显减轻患者疼痛,有效恢复椎体高度,改善并维持局部矢状面力线,短期疗效满意。

Objective To evaluate the efficacy and safety of lumbar traction followed by bone cement augmentation for severe osteoporosis vertebral compression fractures(SOVCFs)combined with endplate-disc complex(EDC)injury.Methods Twelve patients with SOVCFs combined with EDC injury treated from January 2019 to December 2020 were retrospective analyzed.Lumbar traction was performed to obtain partial reduction of the injured vertebra,followed by functional spinal unit(consisting of fractured vertebra,the injured EDC and the adjacent vertebra)bone cement augmentation.Results The average follow up duration was 24.3 months(14-35 months).All the patients obtained follow up without severe complications,such as vascular nerve injury,spinal infection and pulmonary embolism.After lumbar traction,the local kyphosis Cobb angle was decreased com-pared with admission,the average Cobb angle was 26.2°(18.9°-30.5°);at the final follow up,the average Cobb angle was 19.00(15.6°-23.8°).After lumbar traction,the anterior vertebral height was increased compared with admission,the average anterior vertebral height was 26.8 mm(18.7-31.4 mm);at the final follow up,the average anterior vertebral height was 29.9 mm(18.4-38.6 mm).After lumbar traction,the intervertebral angle was increased compared with admission,the average intervertebral an-gle was 5.2°(2.3°-7.40);at the final follow up,the average intervertebral angle was 5.5°(2.40-7.30).At the final follow up,the average visual analogue scale was 0.8(0-2),the average Oswestry disability index was 16.3%(9%-25%).Conclusion For the treatment of SCOVFs with EDC injury,lumbar traction followed by bone cement augmentation of the fractured vertebra,the in-jured EDC and the adjacent vertebra can effectively relieve pain,obtain vertebral height,improve and maintain the local sagittal alignment,with satisfactory short-term clinical outcomes.