有症状的骨质疏松性重度椎体骨折塌陷的分类及治疗策略  

CLASSIFICATION AND TREATMENT STRATEGIES OF SYMPTOMATIC SEVERE OSTEOPOROTIC VERTEBRAL FRACTURE AND COLLAPSE

作　　者：张顺聪[1,2] 莫凌[1] 梁德[1] 江晓兵[1] 杨志东[1] 唐永超[1] 晋大祥[1] 姚珍松[1] 郭丹青[1] 冯蓬勃[2] 

机构地区：[1]广州中医药大学第一附属医院脊柱专科,广州510405 [2]广州中医药大学第一临床医学院

出　　处：《中国修复重建外科杂志》2016年第2期189-196,共8页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的对有症状的骨质疏松性重度椎体骨折塌陷患者进行分类,探讨其分类治疗方案。方法回顾性分析2010年8月-2014年1月收治的符合选择标准的骨质疏松性重度椎体骨折塌陷患者42例,综合患者症状、体征及影像学资料进行分类。Ⅰ类23例,局部疼痛伴活动受限,但无神经症状及明显后凸畸形,于过伸体位下行经皮椎体强化术17例,后路原位固定、责任椎体钉道强化术6例;Ⅱ类12例,伴有轻度神经症状,后凸Cobb角≤30°,行后路局限性椎管减压、钉道强化内固定术;Ⅲ类7例,伴有严重神经症状,后凸Cobb角〉30°,行后路截骨矫形固定术5例,一期后路椎体次全切除、前柱支撑重建术2例。术前、术后1周及末次随访时采用疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）及后凸Cobb角变化评价患者功能恢复情况,并记录相关并发症发生情况。结果所有患者均顺利完成手术。Ⅲ类患者中1例出现切口深部感染,1例术后血糖应激性增高继发酮症酸中毒,均经相应处理后治愈;其余患者切口均Ⅰ期愈合,原内科疾病无复发或加重。所有患者均获随访,随访时间6~36个月,平均11.6个月。17例患者神经功能获得改善,2例仍存在小便功能障碍。13例（30.95%）出现无症状骨水泥渗漏,其中Ⅰ类7例,Ⅱ类4例,Ⅲ类2例。随访期间,所有患者均未发生骨水泥脱落、内固定物松动等并发症。所有患者术后1周及末次随访时的VAS评分、ODI及后凸Cobb角均较术前明显改善（P〈0.05）,术后1周与末次随访时比较差异无统计学意义（P〉0.05）。结论临床上应针对不同类型骨质疏松性重度椎体骨折塌陷实施个性化治疗方案,以提高手术疗效,降低手术风险及并发症。Objective To investigate the classification and treatment strategies of symptomatic severe osteoporotic vertebral fracture and collapse. Methods Between August 2010 and January 2014, 42 patients with symptomatic severe osteoporotic vertebral fracture and collapse were treated, and the clinical data were retrospectively analyzed. According to clinical symptom and imaging materials, 23 cases were classified as type I（local pain, limitation of motion, no neurological symptom, and no obvious deformity）, 12 cases as type II（slight neurological symptom and kyphotic Cobb angle ≤ 30°）, and 7 cases as type III（severe neurological symptom and kyphotic Cobb angle 30°）.In 23 type I patients, 17 underwent percutaneous vertebral augmentation, 6 underwent posterior pedicle screw fixation strengthened with bone cement combined with percutaneous vertebral augmentation. In 12 type II patients, they were treated with local spinal decompression and internal fixation strengthened with bone cement. In 7 type III patients, 5 underwent posterior osteotomy, and 2 underwent one stage posterior approach of vertebral resection and reconstruction. The visual analogue scale（VAS）, Oswestry disability index（ODI）, and local kyphotic Cobb angle were used to evaluate the neurological function. The complications were recorded. Results The operation was successfully completed in all patients. Wound infection and ketoacidosis secondary to stress blood glucose rise occurred in 1 case of type III patients respectively, and were cured after corresponding treatment; primary healing of wound was obtained in the other patients. The patients were followed up from 6 to 36 months（mean, 11.6 months）. The nerve function was improved in 17 cases, and micturition disability was observed in 2 cases. Asymptomatic cement leakage occurred in 13 cases（30.95%）（7 cases in type I, 4 cases in type II, and 2 cases in type III）. No bone cement dislocation and internal fixation failure were found during follow-up. The VAS score, ODI, and t

关 键 词：骨质疏松 椎体骨折塌陷 经皮椎体强化术 钉道强化 截骨矫形术 分类治疗 

分 类 号：R687.3[医药卫生—骨科学]