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| 骨质疏松性椎体压缩骨折合并腰椎退变性疾病的治疗策略及疗效观察 |
| Treatment strategy and efficacy observation of osteoporotic vertebral compression fractures combined with lumbar degenerative diseases |
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| DOI：10.3969/j.issn.1006.7108.2013.07.006 |
| 中文关键词: 骨质疏松性椎体压缩骨折 腰椎退变性疾病 椎体后凸成形术 椎体后外侧融合术 |
| 英文关键词:Osteoporotic vertebral compression fractures Lumbar degenerative diseases Percutaneous kyphoplasty Posterolateral fusion |
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| 中文摘要: |
| 目的 探讨椎体后凸成形术结合后外侧融合术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures, OVCFs)合并腰椎退变性疾病(lumbar degenerative diseases, LDD)的临床疗效。方法 收集本院2007年5月至2009年6月间，12例OVCFs(男5例，女7例)合并不同程度LDD的患者，依据患者术前症状、体征结合X线片、CT及MRI进行综合分析，采用一期后路腰椎间盘切除、椎体后外侧融合(posterolateral fusion PLF )+伤椎椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗。采用JOA评分评估患者腰背痛及下肢神经功能的恢复情况；SF-36健康调查评分表评估患者生活质量；定期拍摄脊柱正侧位X线片、CT和/或MRI评估患者术后骨折椎体复位、后凸矫正及并发症发生情况。结果12例患者均顺利完成手术。平均手术时间170 min，平均骨水泥注射量5.3ml，术后随访12~36个月，平均25个月，所有患者腰背痛及患肢神经症状明显缓解，椎体前缘高度和后凸角度术前分别为13. 2±2. 8 mm和29.7°±10.5°，术后分别为21. 8±3. 4 mm和16.2°±8. 4°，椎体后缘高度术前、术后和随访期间均无显著变化；术前及末次随访时JOA评分分别为9. 46±2. 58和21. 52± 3. 55，手术前后有显著性差异(P<0. 05 )，随访过程中未发现椎体高度再丢失、后凸畸形加重及患肢神经症状的复发。患者SF-36健康调查评分术后均有显著提高。1例患者术中出现骨水泥渗漏，术后未出现临床症状。结论OVCFs合并LDD，采用PLF+PKP治疗，能够使患者腰背痛及患肢神经症状明显缓解并可早期下地活动、功能锻炼，减少长期卧床并发症，是一种安全、有效的治疗方法。 |
| 英文摘要: |
| Objective To investigate the efficacy of percutaneous kyphoplasty(PKP) and posterolateral fusion(PLF) for the treatment of osteoporotic vertebral compression fractures(OVCFs)combined with lumbar degenerative diseases (LDD). Methods A total of 12 patients，who had OVCFs combining with different degrees of LDD from May 2007 to Jun 2009，including 5 men and 7 women, were involved in this study. The clinical data of all the patients were analyzed, including preoperative symptoms and manifestations, the results of X-ray, CT, and MRI. The patients received PKP with PLF. Preoperative and postoperative pain level, JOA score and SF-36 score, vertebral height restoration, and local kyphosis correction and complications were recorded and analyzed. Results The operations of 12 patients were successful, with an average operation time of 170 minutes and an average 5 ml injection of bone cement. All for an average of 25 months(from 12 to 36months).The back pain of all the patients and the the cases were nerve symptoms followed up of affected limbs relived significantly. The mean height of anterior and local kyphosis correction before the operation were 13.2±2. 8mm and 29.7°±10.5 °，respectively, which were 21.8±3.4 mm and 16.2°±8.4° after the operation respectively. No significant changes of the posterior vertebral height before and after the operation were observed. The JOA score before the operation and at the last follow-up was 9. 46±2. 58 and 21. 52±3. 55，respectively, and the difference was significant(P<0.05).During the whole period of follow-up, no re-loss of vertebral height, aggravation of kyphosis, and recurrence of nerve symptoms of the affected limbs were observed. Postoperatively, 6 of 8 subscales measured by SF-36 were significantly improved. One patient had the complication of cement leakage after the operation, but with no clinical symptom. Conclusion PKP with discectomy and PLF is effective and relatively safe for the treatment of OVCFs combined with LDD，which can relive the back pain and nerve symptoms of the affected limbs，allow patients to do exercises off the bed at the early stage, and reduce the complication in the bed. |
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