老年骨质疏松性不稳定胸腰椎骨折的手术治疗  

Surgical treatment of unstable thoracolumbar fracture associated with osteoporosis in elderly

作　　者：徐龙伟[1] 季卫平[1] 李浩[1] 赵鹏飞[1] 沈永辉[1] 

机构地区：[1]丽水市人民医院骨科,浙江丽水323000

出　　处：《临床骨科杂志》2010年第1期19-21,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨老年骨质疏松性不稳定胸腰椎骨折的最佳手术方式及疗效。方法对老年骨质疏松性不稳定胸腰椎骨折24例采用个体化手术方案:骨质疏松置钉困难者行钉孔聚甲基丙烯酸甲酯(PMMA)强化椎弓根螺钉,骨折脱位及病椎相邻椎体有陈旧骨折者行长节段固定;有神经症状及椎管占位>30%者均行半椎板减压,后路颗粒骨植骨或复合经椎弓根植骨。结果椎体前缘压缩率由术前(42.8±4.5)%减少到(7.6±2.3)%(P<0.05),矢状位Cobb角由术前(32.5±5.2)°恢复至(5.4±2.5)°(P<0.05),椎管占位由术前(34.6±7.2)%恢复至(3.7±2.1)%(P<0.05)。随访1年时上述各指标较术后1周时无明显改变(P>0.05)。神经功能Frankel分级:A级4例恢复至C级1例,3例无恢复;B级3例恢复至C级1例、D级2例;C级5例恢复至D级4例、E级1例;D级8例均恢复至E级;E级4例无变化。腰背痛发生率12.5%,无内固定失效病例。结论个体化手术方案是老年骨质疏松性不稳定胸腰椎骨折有效的治疗方法。Objective To study clinical results and the optimal operative method of surgical treatment for unstable thoracolumbar fracture associated with osteoporosis in elderly.Methods 24 elderly patients with unstable thoracolumbar fracture associated with osteoporosis were treated with personalized surgical plan：augmentation of pedicle screw fixation with polymethylmethacrylate（PMMA） for osteoporotic thoracolumbar vertebrae fracture,long-segment internal fixation for thoracolumbar fracture with old adjacent vertebral fracture or the thoracolumbar fracture dislocation,semi-laminectomy decompression for treatment of thoracolumbar fracture with spinal cord injury or occupancy of vertebral canal over 30%,and posterior autologous morselized bone graft or combined transpedicular bone graft for spinal fusion.Results The anterior body compression was restored from mean preoperative（42.8±4.5）% to（7.6±2.3）%（P0.05） postoperatively.The preoperative averaging Cobb angle on sagittal plane recovered from（32.5±5.2）°to（5.4±2.5）°（P0.05） and the preoperative occupancy of vertebral canal averaging recovered from（34.6±7.2）% to（3.7±2.1）%（P〈0.05）.After 1 year follow-up,the changes of the above-mentioned index was no statistically significant（P0.05）.According to Frankel grading system,in 4 cases of grade A,1 case was improved to grade C,3 got no improvement;In 3 cases of grade B,1 was improved to grade C,2 to grade D;In 5 cases of grade C,4 improved to grade D,1 to grade E;All 8 cases of grade D improved to grade E.4 cases of grade E got no change.The rate of back pain occurrence was 12.5%.There was no failure of internal fixation.Conclusions The treatment of unstable thoracolumbar fracture associated with osteoporosis with personalized surgical plan is an effective method.

关 键 词：骨质疏松 胸椎 腰椎 脊柱骨折 骨折固定术 内 

分 类 号：R681.4[医药卫生—骨科学] R683.2[医药卫生—外科学]