骨质疏松性胸腰椎骨折不愈合的诊断与治疗  

Diagnosis and treatment of nonunion of osteoporotic thoracolumbar vertebral fractures

作　　者：杨惠林[1] 王根林[1] 牛国旗[1] 周军 蔡鑫[1] 史金辉[1] 唐天驷[1] 

机构地区：[1]苏州大学附属第一医院骨科,215006

出　　处：《中华骨科杂志》2007年第9期682-686,共5页Chinese Journal of Orthopaedics

基　　金：江苏省135重点学科基金资助项目（RC2003091）

摘　　要：目的探讨骨质疏松性胸腰椎骨折不愈合的临床表现、影像学特点、诊断及治疗方法。方法回顾性分析2003年4月至2005年5月收治的9例（9椎）骨质疏松性胸腰椎骨折不愈合患者的临床资料并复习相关文献，总结骨质疏松性椎体骨折不愈合的特点。男4例，女5例；年龄60-85岁，平均71-4岁。T12 4例，L1 4例，L2 1例。均行X线片和MR检查，其中4例行CT检查。所有患者均采用球囊扩张椎体后凸成形术治疗，测量手术前后椎体前缘高度变化及采用视觉模拟数字法判断腰背部的疼痛变化，以此评估手术疗效。结果所有患者术前均有腰背部疼痛，特点是卧床休息时疼痛消失或明显减轻，坐及行走等脊柱承受负荷时疼痛复发。X线片或CT可见不愈合椎体内有裂隙，边缘硬化，可表现为假关节形成；椎体内裂隙在MRI的T1加权像上表现为低信号，T2加权像及脂肪抑制序列上表现为高信号。术后患者疼痛明显减轻或消失，脊柱序列得到改善或恢复正常。结论骨质疏松性胸腰椎骨折与其他骨折一样，也存在骨折不愈合，其诊断主要依靠临床表现和影像学特点。保守治疗常无效而需要手术干预。球囊扩张椎体后凸成形术是较好的治疗方法之一。Objective To explore the clinical situation of osteoporotic throacolumbar vertebral fracture nonunion, imaging characteristics, diagnosis and treatment options. Methods From April 2003 to May 2005, the clinical data of 9 patients with nonunion of osteoporotic thoracolumbar vertebral fractures were studied. There were 4 males and 5 females, with the mean age of 71.4 years （range, 60-85 years）. The fracture vertebrae were 4 cases in T12, 4 in L1, and 1 in L2. All cases received radiography and MRI examination, 4 patients received CT examination. All patients were treated using kyphoplasty. The curative effect of kyphoplasty was evaluated by measuring back pain at preoperative, postoperative and followed-up time. Also, anterior vertebral border high was measured at preoperative, postoperative and followed-up time. Results All cases had back pain before operation. The back pain had a certain feature that was distinctly proportional to activity and position, which was almost completely relieved by rest while the symptom returned as soon as the patients was loaded in attempting to sit, stand, or walk. Imaging characteristics of the nonunion were intravertebral clefts or so-called vacuum phenomena on vertebral imaging views as well as dynamic mobility which refered to a change of vertebral height or configuration with changes in body positioning. The cleft could be detectable on T2-weighted MR images and short tau inversion recovery MR images as an area of high signal intensity and on Tl-weighted MR images as an area of low signal intensity. All patients had immediate relief of back pain after kyphoplasty operation, and spinal alignment was significantly restored. Conclusion Osteoporotic thoracolumbar vertebral fractures may develop nonunion like other bone fracture. The diagnosis of the fracture nonunion mainly depends on clinical situation and imaging characteristics. The cardinal symptom is refractory to conservative treatments, and these patients often need operative intervention. At present, the best surgical t

关 键 词：骨质疏松 脊柱骨折 骨折 不愈合 

分 类 号：R686[医药卫生—骨科学]