骨水泥强化椎弓根螺钉治疗胸腰椎骨质疏松性骨折伴后凸畸形的研究  

Study of the treatment of osteoporotic thoracolumbar fractures combined with kyphosis with bone cement augmentation of pedicle screws

作　　者：叶森[1] 郝杰[1] 胡侦明[1] 张晓军[1] 沈皆亮[1] 常乐[1] 赵涛 谢作棒 

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《中国骨质疏松杂志》2017年第11期1462-1467,共6页Chinese Journal of Osteoporosis

摘　　要：目的观察骨水泥强化椎弓根螺钉治疗胸腰椎骨质疏松性骨折伴后凸畸形的临床疗效。方法随访2013年3月至2016年8月在我院采用骨水泥强化椎弓根螺钉治疗胸腰椎骨质疏松性骨折伴后凸畸形的52例患者,男10例,女42例,年龄55~84岁,平均70.5岁。通过PACS阅片软件测量术前、术后3个月及末次随访脊柱局部后凸Cobb角来观察后凸畸形矫正情况,通过比较术前及术后腰背部疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍评分(oswestry disability index,ODI)评估患者生活质量。应用ASIA分级系统对神经功能进行评估。收集患者围手术期并发症及骨水泥相关并发症发生情况。结果 52例患者手术共458枚椎弓根螺钉置入了232个椎体中,骨水泥强化了282枚螺钉(61.6%)和146个椎体(62.9%),胸椎平均每个钉道使用骨水泥(2.03±0.52)mL,腰椎平均每个钉道使用骨水泥(2.43±0.88)mL。随访3~56个月,平均19.2个月。术前腰背部疼痛VAS评分为(6.54±1.26)分、ODI评分为(69.06±13.26)%、局部Cobb角为(23.88±13.73)°,末次随访腰背部疼痛VAS评分为(1.88±0.68)分、ODI评分为(20.74±5.91)%、局部Cobb角为(11.07±8.96)°,与术前相比明显改善,差异具有统计学意义(P<0.001)。术前7例神经损害患者ASIA分级为C级2例、D级5例,术后提高至D级2例、E级5例。强化282枚螺钉中有1枚出现骨水泥向椎弓根内侧壁渗漏,经术中及时清除后未出现神经功能障碍加重;11枚发生骨水泥向椎体前方渗漏,13枚发生骨水泥渗漏进入椎间盘内,术后均无临床症状。458枚螺钉均无松动、断裂。结论骨水泥强化椎弓根螺钉治疗胸腰椎骨质疏松性骨折伴后凸畸形既提高了螺钉的稳定性,又矫正了后凸畸形。Objective To investigate the clinical efficacy of bone cement augmentation of pedicle screws on osteoporotic thoracolumbar fractures combined with kyphosis.Methods From March 2013 to August 2016,52 patients with osteoporotic thoracolumbar fractures combined with kyphosis received bone cement augmentation of pedicle screws treatment.There were 10 males and 42 females with an average age of 70.5（55-84） years old.The Cobb angle of kyphosis were measured using a PACS software preoperatively,3 months postoperatively,and at the final follow-up.The thoracolumbar Visual Analogue Scale（VAS）and the Oswestry Disability Index（ODI） were evaluated for life quality preoperatively and postoperatively.The ASIA neurologic grading system was recorded to evaluate the neurological function.Perioperative complication and bone cement related complication were collected.Results A total of 52 patients underwent placement of 458 pedicle screws in 232 vertebrae,and 282 augmented screws（61.6%） were inserted in 146 vertebrae（62.9%）.The mean amount of bone cement was 2.03±0.52 ml in a thoracic nail and 2.43±0.88 ml in a lumbar nail.The mean follow-up duration was 19.2（3-56） months.The perioperative thoracolumbar VAS score,ODI,and Cobb angle were 6.54±1.26,（69.06±13.26） %,and（23.88±13.73） °,respectively,and they were 0.62±0.75,（20.74±5.91） %,and（11.07±8.96） °,respectively,at the final follow-up.The differences were statistically significant（P〈0.001）.In 7 patients with neuro-damage,the ASIA grading was C in 2 case and D in 5 cases before surgery.It increased to D in 2 case and E in 5 cases at the final follow-up.One out of 282 augmented pedicle screws appeared cement leakage flowing inside of pedicle through damaged posterior wall,but no serious neurologic impairment occurred after elimination of the cement during the operation.Cement leakage into anterior vertebral body were found in 11 patients,and cement leakage into the vertebral disc occurred in 13 patients.None of the patients had ne

关 键 词：骨质疏松 椎弓根螺钉 骨水泥 脊柱骨折 后凸畸形 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]