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目的探讨椎弓根螺钉结合椎体成形术治疗椎管狭窄症伴狭窄节段骨质疏松性压缩骨折疗效。方法 2009年1月至2014年5月,我院收治椎管狭窄症伴狭窄节段老年性骨质疏松性压缩骨折患者15例,其中男9例,女6例。年龄58~81岁,平均(69.9±7.26)岁。所有患者在压缩性骨折椎体经椎弓根注入骨水泥,行椎弓根螺钉强化,其它减压范围的椎体直接拧入椎弓根螺钉,后行椎管减压。评价术前1天、术后1周及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(oswestry disability index,ODI)评分,评估患者腰痛、下肢痛及生活质量改善情况;对比病椎后凸畸形角度(Cobb’s角)和骨折椎体高度恢复情况。结果所有患者均顺利完成手术,置入螺钉过程中发生骨水泥渗漏4例,无放热效应及毒性反应引起的并发症;术后腰痛及下肢痛明显缓解,腰痛VAS评分由术前(8.43±1.34)分下降至术后1周(3.21±0.91)分,末次随访时为(2.36±0.79)分;腿痛VAS评分由术前(7.53±1.72)分下降至术后1周(2.64±0.85)分,末次随访时为(1.84±0.60)分;ODI评分由术前(58.63±4.53)分下降至术后1周(28.40±2.45)分,末次随访时为(26.40±2.14)分。腰、腿痛VAS评分、ODI评分术后与术前比较差异均有统计学意义(P<0.05)。Cobb’s角变化、椎体高度变化术后与术前比较差异无统计学意义(P>0.05)。15例获得12~36个月随访,平均(22.4±8.5)个月,随访中无椎弓根螺钉松动、断裂或拔出,无相邻椎体的压缩骨折,螺钉周围未见透亮线的出现。结论骨折椎体注入骨水泥并椎弓根螺钉锚定的椎管扩大减压内固定术治疗椎管狭窄症伴狭窄节段骨质疏松性压缩骨折效果良好,能有效地缓解腰背部疼痛,改善患者功能,提高生活质量。
Objective To investigate the effect of pedicle screw combined with vertebroplasty in the treatment of spinal stenosis with stenotic osteoporotic fractures. Methods From January 2009 to May 2014, 15 cases of osteoporotic fractures of the elderly with spinal stenosis and stenosis were admitted to our hospital, including 9 males and 6 females. Age 58 to 81 years, mean (69.9 ± 7.26) years. All patients underwent vertebral pedicle screw compression in the vertebral body of vertebral compression fractures. The vertebral bodies in the other decompression range were directly screwed into the pedicle screw and decompression was performed. The patients were evaluated for pain relief, lower extremity pain and quality of life by assessing the visual analogue scale (VAS) and the Oswestry disability index (ODI) at 1 day before surgery, 1 week after surgery and at the last follow-up. ; Compare the angle of kyphosis (Cobb’s angle) and vertebral body height recovery. Results All the patients underwent surgery successfully. There were 4 cases of bone cement leakage during the screw placement, with no exothermic effect and complication caused by toxic reaction. The postoperative low back pain and lower extremity pain relief were relieved. The VAS score of lumbago was decreased from 8.43 ± 1.34) to 1 week (3.21 ± 0.91), and (2.36 ± 0.79) at the last follow-up. The VAS score of leg pain decreased from 7.53 ± 1.72 to 1.64 ± 0.85 (1.84 ± 0.60) at the final follow-up. The ODI score decreased from 58.63 ± 4.53 to 28.40 ± 2.45 at the end of follow-up, and was 26.40 ± 2.14 at the final follow-up. Waist and leg pain VAS score, ODI score postoperative and postoperative differences were statistically significant (P <0.05). There was no significant difference in Cobb’s angle and vertebral height between postoperative and preoperative (P> 0.05). Fifteen patients were followed up for 12 to 36 months with an average of (22.4 ± 8.5) months. No pedicle screw loosening, rupture or pull-out occurred during follow-up. There was no compression fractures of the adjacent vertebral bodies. No translucent lines appeared around the screws . CONCLUSIONS: Spinal fractures with vertebroplasty and decompression for pedicle screw fixation for the treatment of spinal stenosis with stenotic osteoporotic compression fractures are effective in relieving the pain of lower back and back and improving Patient function, improve quality of life.