骨水泥强化椎弓根钉结合经皮椎体成形术治疗老年性骨质疏松椎体压缩性骨折合并椎管狭窄症  

Augmented pedicle screws combined with percutaneous vertebroplasty in treatment of senile osteoporotic vertebral compression fractures complicated with spinal stenosis

作　　者：邹海波[1] 绳厚福[1] 李中实[1] 谭明生[1] 韦竑宇[1] 移平[1] 杨峰[1] 蒋欣[1] 唐向胜 陈栋[1] 赵景鑫[1] 

机构地区：[1]北京中日友好医院骨科-脊柱外科,北京100029

出　　处：《颈腰痛杂志》2015年第2期93-99,共7页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨骨水泥强化椎弓根螺钉结合经皮椎体成形术治疗老年性骨质疏松椎体压缩性骨折合并椎管狭窄症的治疗方法及疗效。方法从2011-09-2013-10,共7例患者因椎体压缩性骨折合并有椎管狭窄症在北京中日友好医院骨科-脊柱外科治疗,行经皮椎体成形术或开放手术后行椎弓根钉的骨水泥强化。评价PVP手术前后椎体的变化,分别测量术前及术后骨折椎体前缘、中央及后缘高度的比率及节段Cobb角的变化。评价骨水泥强化椎弓根螺钉采用测量手术后及末次随访时椎弓根螺钉固定点与椎体下上终板的距离以及手术节段Cobb角度的变化。X线片及CT扫描观察骨水泥在椎体内的分布情况。结果压缩性骨折的椎体,术前和术后的骨折椎体前缘、中央及后缘高度的比率没有统计学上的差异(P>0.05),但与术前相比三者的数值是增加的。矢状面Cobb角度手术前后的差异具有统计学意义(P<0.05)。椎管减压,骨水泥强化椎弓根螺钉的患者,矢状面Cobb角度,手术前后的差异没有统计学意义(P>0.05)。结论老年骨质疏松合并椎管狭窄症的患者,在进行减压的同时,需要对椎弓根钉进行强化处理,且要对所有的螺钉均进行骨水泥的强化。Objective To explore the curative methods and effect of augmented pedicle screws combined with percutaneous vertebroplasty （PVP） in the treatment of senile osteoporotic vertebral compression fractures complicated with spinal stenosis. Methods From September 2011 to October 2013,7 patients with osteoporotic vertebral compression fractures complicated with spinal stenosis were treated in our department. There were 2 men and 5 women,aged from 69 to 85 years （average 76.4 years old）. Pre-operative examination included X-ray,CT and MRI scan. The patients＇general condition was assessed before operation to confirm no surgical con- traindications. To evaluate the changes of vertebral body for PVP procedure,anterior vertebral body height ratio （AVBHr）,midline vertebral body height ratio（MVBHr）,and posterior vertebral body height ratio（PVBHr） vertebral body height ratio and sagittal segmental vertebral wedge an- gle （Cobb＇s angle） were measured preoperatively and postoperatively. To evaluate the changes of polymethylmethacrylate（PMMA） augmented pedicle screws,the distance from the screw to the in- ferior and upper endplate of vertebra were measured immediately after the operation and the fi- nal follow-up. The Cobb＇s angle was measured preoperatively,postoperatively and final follow-up.The distribution of bone cement in the vertebral body was assessed by X-ray and CT scan. Re- sults For Vertebral compression fracture,the values of AVBHr,PVBHr and MVBHr had no signifi- cant differences at pre- and postoperation （P＇M3.05）. But compared with preoperation,the Values in- creased. The difference of Cobb＇s angle was statistically significant （P〈0.05）. Overall,there were 48 pedicle screws inserted in this series, only 38 screws were augmented with cement. The distance from the screw to the inferior and upper endplate of vertebra were 10.28 mm and 10.02 mm after operation,the final follow-up were 5.86 mm and 6.04 mm. There was no statistically significant difference （P〉0.05）. Co

关 键 词：骨质疏松症 椎体压缩性骨折 椎管狭窄症 强化的椎弓根螺钉 

分 类 号：R589[医药卫生—内分泌]